The outcome of this course is for the learner to describe the normal stages of sleep, common sleep measurement tools sleep characteristic, common sleep disorders, the changes that affect the quality and quantity of sleep as an individual ages, and methods the healthcare provider can use to assess and assist clients with sleep disorders.

1. Sleep Disorders
Judy D’Angelo RN MSN ANP LNC CDP CADDCT
Wilson Shepard Education Associates
http://www.wshep.com
585-360-4192
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Approval Code #20-732648

2. Course Description
The outcome of this course is for the learner to
1.Describe the normal stages of sleep,
2.Describe common sleep measurement tools
3.Discuss sleep characteristics,
4.Discuss common sleep disorders,
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3. Why is important?
 Sleep problems are a very real epidemic resulting in
catastrophic effects on our bodies and our minds.
 According the National Sleep Foundation (2018), one
out of every two people will suffer from sleeplessness at
some point in their lives.
 Approximately 30 to 40 million Americans suffer from
insomnia that affects the quality of their sleep and their
health.
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4. Sleep
 Sleep is not just a “resting brain”
 Sleep is complex, highly organized, physiological state
 It is crucial to the proper
 Functioning
 Restoration
 Repair of our bodies
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5. Sleep
 Sleep is a term derived from the Latin word “somnus”
meaning –
 Sleep is
 Natural
 Periodically recurring physiological state of rest for the
body and mind
 Sleep is defined as a behavioral state characterized by little
physical activity and virtually no awareness of the outside
world.
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6. How is Sleep Regulated?
 Regulated by hypothalmus that contains
 Both a sleep center
 Wakefulness center
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7. Sleep Deprivation
Sleep debt can cause
Increased irritability
Mood problems
Decreased concentration
Ineffective judgment
Inability to perform simple tasks
Decreased productivity - or
Catastrophic accidents
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9. Sleep Architecture
 Consists of two distinct brain states or “Sleep
Architecture”
 Rapid Eye movement (REM)
 Non-rapid eye movement (NREM)
 Each States alternates every 90 minutes (National Sleep
Foundation, 2018). Both are necessary to quality sleep.
 Getting the right “mix” of both REM & NREM helps
maintain normal sleep architecture and restorative sleep.
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10. REM Sleep
The dream stage of sleep
It occurs about 90 minutes after falling asleep and increases
over the later part of the night.
Each episode lasts 30 minutes or less.
Eye movement occurs in bursts
Major muscle groups may exhibit a form of paralysis while
peripheral muscles may twitch.
Breathing patterns are irregular.
There is no temperature regulation, so shivering and
sweating cease.
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12. REM Sleep
 Important for daytime performance and may contribute
to memory consolidation.
 Approximately 25% of a night’s sleep is spent in this
stage (National Sleep Foundation, 2018).
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13. NREM Sleep
 Divided into 4 stages
 Stage 1 – is that state of sleep in which the muscles relax,
and the brain waves are rapid and irregular. This is a
light stage of sleep, between being awake and entering
sleep.
 Stage 2 – Intermediate sleep is characterized by an
increase in brain wave size and bursts of electrical
activity.
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14. NREM Sleep
 Stages 3 & 4 – exhibit large, slow brain waves (“delta
waves”
 This “delta wave” is also called deep sleep and provides
the individual with rest and restoration.
 Breathing slows, blood pressure drops, and hormones are
released for growth and development.
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16. Sleep Patterns
 Most adults need 7-9 hours of sleep daily
 Amount of sleep varies among individuals
 Amount of sleep needed is defined as the amount that
allows an individual to function throughout the day
without feeling drowsy or having impaired concentration
(National Sleep Foundation, 2018).
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17. Sleep
The following characteristics:
Reduced (but not absent response) – person responds to
internal and external stimuli.
Reversibility: One can awaken from sleep
Minimal Movement: humans may walk and talk in their
sleep (sleep waking).
Species-specific posture: some animals sleep with their eyes
open: humans sleep lying down with eyes closed.
Species-specific diurnal timing and duration: humans sleep
about 8 hours per day.
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18. What differentiates sleep from coma?
According to Borbely, Achermann, Geering and Tobler
(2018) sleep consists of three hypothesized processes.
A homeostatic process
 This process is determined by the amount of sleep and
waking an individual has experienced.
 Reductions of as little as 1-2 hours of sleep accumulated
over several nights can result in measureable daytime
sleepiness.
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19.  A circadian process
 This process organizes alterations of sleep and waking
over 24-hour day.
 This light-dark cycle affects our biological clock
 Body temperature and the desire to sleep parallel these
cycles.
 Hormonal and metabolic processes are affected by sleep:
 Cortisol is released
 Prolactic and growth hormone
 Melatonin
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What differentiates sleep from coma?

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21. Sleep Measurement Tools
 The stages of sleep can be characterized by observing an
individual’s behavior.
 Measurement of these stages and the subtleties of sleep
are most effectively analyzed through the continuous
and simultaneous recordings of several tests.
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22.  Electroencephalography (EEG) – during this nighttime
test, electrodes are placed all around the patient’s head to
determine at any give time, which stage of sleep the
person may be in.
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Sleep Measurement Tools

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24.  Electrooculography (EOG) – this test involves the
placement of electrodes on the outside of each eye. It
helps the examiner determine sleep stages from the
movements of the patient’s eyes during sleep.
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Sleep Measurement Tools

25.  Electroencephalography (EEG)
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Sleep Measurement Tools

26.  Electromyography (EMG) – during this test, electrodes
are placed on the chin and each calf muscle to measure
muscle movement during sleep.
 This recording demonstrates a wake period, an arousal,
or spastic movement.
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Sleep Measurement Tools

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28. Sleep Disorders - Insomnia
 Defined as disturbed sleep in the presence of an adequate
opportunity and circumstance for sleep.
 It is the most common sleep disorder.
 Insomnia in older adults is associated with significant
morbidity and mortality.
 Characterized by difficulty falling asleep or difficulty
staying asleep.
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29. Can be caused by
 Stress
Depression
Anxiety
Physical illness
Caffeine
Pain
Drugs
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Sleep Disorders - Insomnia

30. Sleep Disorders – Sleep Apnea
 Literally mean “want of breath”
 Affects approximately 18 million Americans
 It is a serious condition
 Decreases in blood oxygen saturation, increases in blood
carbon dioxide levels, morning fatigue, headaches,
depression and cognitive impairment (Meiner, 2014).
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33. Narcolepsy
 Characteristics
 Frequent and overwhelming urge to sleep
 Sleep attacks can occur at any time of day
 Can last for a few seconds to over 30 minutes
 Currently no cure
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34.  Cataplexy – sudden loss of muscle control brought on by
strong emotions (such as laughter, anger, surprise) so the
individual my literally fall to the ground.
 Sleep paralysis: the inability to move or speak during the
transition into sleep or wakefulness.
 Hypnagogic hallucinations – vivid dream like images
that my be frightening or mundane during the transition
from sleep to wakefulness.
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Narcolepsy Characteristics

35. Parasomnias
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36. How do I get credit for this?
 Once you have completed the review, you will need to
complete an evaluation form;
 It can be found at
 https://www.wshep.com/sleep-disorder-evaluation-.html
 Thank you again for your participation.
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