This document summarizes key aspects of sleep and sleep disorders. It discusses the physiological changes that occur during the different sleep stages of NREM and REM sleep. It also outlines different types of sleep disorders including dyssomnias like insomnia and hypersomnia, and parasomnias involving abnormal events during sleep. Specific disorders covered include sleepwalking, night terrors, sleep talking and bruxism. Nursing assessments and interventions for managing sleep disorders are also summarized.
2. THE WORST THINGS;
TO BE IN BED AND SLEEP NOT,
TO WANT FOR ONE WHO COMES
NOT,
TO TRY TO PLEASE AND PLEASE
NOT
3.
4. Sleep can be regarded as a physiological
reversible reduction of conscious awareness.
It is observed in all mammals, all birds, and
many reptiles, amphibians, and fish.
5. Accounts for nearly 1/3rd of our lives
A natural behavioural state
characterized by:
Reduction in voluntary motor activity
Decreased response to stimulation
(i.e., increased arousal threshold)
Stereotyped posture
6. There are two types of sleep, non-rapid eye-
movement (NREM) sleep and rapid eye-
movement (REM) sleep.
NREM sleep is divided into stages 1, 2, 3, and
4, representing a continuum of relative depth.
7. Entered through NREM
REM sleep dominates last third of night
REM sleep: 20-25% total sleep time
8. In normal persons, NREM sleep is a
peaceful state relative to waking.
The pulse rate is typically slowed five to ten
beats a minute below the level of restful
waking and is very regular.
Respiration is similarly affected, and blood
pressure also tends to be low, with few
minute-to-minute variations.
9. Episodic, involuntary body movements are
present in NREM sleep.
Blood flow through most tissues, including
cerebral blood flow, is slightly reduced.
10. Pulse, respiration, and blood pressure in
humans are all high during REM sleep, much
higher than during NREM sleep and often
higher than during waking.
Brain oxygen use increases during REM sleep.
Thermoregulation is altered during REM sleep.
11. REM SLEEP NON- REM SLEEP
Rapid conjugate eye
movement
Absence of eye movement
Fluctuation of vital signs Stable vital signs
Muscle twitching No muscle twitching
Presence of dreams No dreams
Originate in pontine
reticular formation
Originates in midline
pontine and medullary
nuclei (raphe nuclei)
Mediated by noradrenaline Mediated by serotonin
12. Sleep is divided into a 90 minute cycle of NREM
sleep and REM sleep.
This cycle is repeated 3-6 times during the night.
Generally, a night of sleep begins with about 80
minutes of NREM and 10 minutes of REM sleep.
There is more REM sleep on towards morning,
which explains why when you awaken in the
morning, you generally awaken from a dream.
15. Sleep disorders are divided into subtypes;
Dyssomnias
Insomnia
Hypersomnia
Disorders of sleep-wake schedule
Parasomnias
Stage IV disorders
Other disorders
16. Dyssomnias
They are primarily psychogenic conditions
in which the predominant disturbance is in the
amount, quality or timing of sleep is due to
emotional causes.
17. Parasomnias
They are abnormal episodic events
occurring during sleep; in childhood, these are
related mainly to the child’s development,
while in adulthood, they are primarily
psychogenic.
18.
19. It refer to the disorder of initiation and
maintenance of sleep. This includes frequent
awakening during night and early morning
awakening.
20. Etiology
Medical illness
Alcohol and drug abuse
Psychiatric disorders
Social causes
Behavioral factors
21. Individuals describe themselves as feeling tense,
anxious, worried, or depressed at bedtime and as
though their thoughts are racing
They frequently ruminate over getting enough
sleep, personal problems, health status and even
death.
Use of alcohol and other substances.
22. In the morning, they frequently report feeling
physically and mentally tired; during the day,
they characteristically feel depressed, worried,
tense and preoccupied with themselves.
Difficulty in falling asleep at night or getting back
to sleep after waking during night.
23. Sleep is light, fragmented or unrefreshing
Need to take something in order to get sleep
Sleepiness and low energy during the day.
24. TREATMENT
Thorough medical and psychiatric assessment
Polysomnography
Treatment of underlying physical/psychiatric disorder
Withdrawal of current medications
Benzodiazepines for short periods
Non-benzodiazepine hypnotic
Opioids
Melatonin
Low doses of atypical antipsychotics
25. Non-pharmacologic management
Progressive relaxation
Autosuggestion
Meditation, yoga
Stimulus control therapy
Do not use bed for reading or chatting-go to bed
for sleep only
26. Sleep hygiene
Sleep as much as needed to feel rested; do not
oversleep
Exercise regularly
Avoid forcing to sleep
Keep a regular sleep and awakening schedule
Avoid caffeinated drink at bedtime
Avoid ‘night caps’
Do not go to bed hungry
Adjust room environment
Do not go to bed with worries
Back rub, warm milk and relaxation exercises.
27.
28. It is also known as Disorder Of Excessive
Somnolence (DOES)
29. Hypersomnia is characterised by
recurrent episodes of excessive daytime
sleepiness or prolonged night-time sleep. It
includes sleep attacks during daytime, sleep
drunkenness (person needs much more time to
awaken, and during this period he is confused or
disoriented).
30. Etiology
Narcolepsy(Excessive daytime sleepiness
characterized by sleep attacks, cataplexy, sleep
paralysis and hypnagogic hallucinations)
Sleep apnoea
Kleine –Levin syndrome (Periodic episodes of
hypersomnia)
31. Dysfunctions in autonomic nervous system
Drug or alcohol abuse
Certain medications
Medical conditions like multiple sclerosis,
depression, encephalitis, epilepsy, obesity etc.
32. Clinical features
Persons are compelled to take nap during day at
inappropriate times
Disoriented sometimes
Anxiety, increased irritation, decreased energy,
restlessness, slow thinking, slow speech, anorexia,
hallucinations and memory difficulty
Poor social, occupational and family functioning
33. TREATMENT
Symptomatic treatment
Changes in behavior and diet
Avoiding alcohol
Stimulants like amphetamine, methylphenidate and
modafinil
Clonidine, levodopa, bromocriptine
Antidepressants, MAO inhibitors
34.
35. It is characterized by a disturbance in
the timing of sleep. The person with this
disorder is not able to sleep when he
wishes to, although at other times he is
able to sleep adequately.
36. It is a form of dyssomnia caused by a
conflict between a person’s circadian
rhythm and the socio-economic demands of
society, such as work and travel schedules.
37. Causes
Jet lag or rapid change of time
zone
Work shift from day to night
Unusual sleep phases (owls
and larks)
41. During sleepwalking episode, the individual
arises from bed, usually during first third of
nocturnal sleep, and walks about, exhibiting
low levels of awareness, reactivity, and motor
skill.
Most often he will return quietly to bed, either
unaided or with a gentle assistance.
Upon awakening, there will be no recall of
event.
42. NIGHT TERRORS
Night terror or sleep terror or pavor
nocturnus, is a parasomnia disorder that
predominantly affects children, causing
feelings of dread or terror.
Children usually described the experience as
“bolting upright” with their eyes wide open,
with a look of fear and panic, and will often
scream.
43. SLEEP-RELATED ENURESIS
Sleep related enuresis or bedwetting,
involves urinating during sleep and occurs
most often during deep sleep.
It is frequently the result of a failure of brain
to engage in appropriate “alarming” of
bathroom needs during sleep before
urination occurs.
44. BRUXISM
It is characterized by the grinding of the
teeth and typically includes the clenching of
the jaw.
While bruxism may be a diurnal or nocturnal
activity, it is bruxism during sleep that causes
majority of health issues and can even occur
during short naps.
45. SLEEP-TALKING (SOMNILOQUY)
It refers to talking aloud in one’s sleep. It
can be quite loud, ranging from simple sounds
to long speeches, and can occur many times
during sleep.
Listeners may or may not be able to
understand what the person is saying.
48. NURSING MANAGEMENT
Assessment
Usual activities in the hour before sleep
Sleep latency
Number and perceived cause of awakenings
Regularity of sleep pattern
Consistency of rising time
Frequency and duration of naps
Ease of falling asleep in places other than the
usual bedroom
Daily caffeine intake
Use of alcohol, sleeping pills and other
medications
49. Objective data may include visible signs of
fatigue and lack of sleep, such as circles
under the eyes, lack of coordination,
drowsiness and irritability.
50. Diagnosis:- Disturbed sleep pattern related to
(specific medical condition),use of or withdrawal
from substances, anxiety or depression, circadian
rhythm disruptions, familial patterns
Interventions:-
To promote sleep:
Encourage activities that prepare one for sleep:
soft music, relaxation exercise or warm bath
Discourage strenuous exercise within one hour of
bed time
51. Control intake of caffeine containing substances within 4
hours of bed time
Provide a high carbohydrate snack before bed time
Keep the temperature of the room between 68-72 degree F
Instruct the client not to use alcoholic beverages to relax
Discourage smoking and other tobacco products near sleep
time
Discourage day time napping
Individuals with chronic insomnia should use sleeping
medication judiciously
52. Diagnosis:- Risk of injury related to excessive
sleeping, sleep terrors, or sleep walking
Interventions:-
Keep the side rails of the bed up
Keep the bed in a low position
Equip the bed with a bell that is activated when the
bed is excited
Keep a night light on and arrange the furniture in
the bedroom in a manner that promote safety
Administer drug therapy as ordered.
53. Diagnosis:- Disturbed sleep pattern related to
enuresis as evidenced by frequent arousal of the
child from bed.
Interventions:-
Assess for anatomical or urinary problems, if any.
lnsist the parents to make the child void before
bedtime
ЕхрІаіn about the availability of bedwetting alarms
Teach bladder stretching exercises
Administer medications as per physician's order.