SLEEP DISORDERS

Goal

At the end of the seminar, students will

be able to gain the knowledge regarding

sleep disturbances & its patterns &

apply this knowledge into providing care

to the client .

Objectives

At the end of the seminar student will be able to:*Define sleep.

*Enlist the factors affecting the sleep.*Discuss about the stages of sleep briefly.

*Explain the short term consciquences of sleep.

*Explain sleep disorder and its management.

*Discuss nursing management of sleep

disturbances.

*Explain role of nurse.

Facts**Man is the only mammal that willingly delays sleep.

**Divorced, widowed and separated people report more insomnia.

**Parents of new babies miss out on 6 months worth of sleep in the first 2 years of their child's life.

**Before alarm clocks were invented, there were "knocker-ups" who went tapping on client's windows with long sticks until they were awake.

**Dysania is the state of finding it hard to get out of bed in the morning.

Facts : cont’d

What is sleep?

“highly structured and well-organized activityfollowing a circadian periodicity that is regulated by theinterplay of internal biological processes and environmentalfactors.”

Physiology of sleep

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. Each has unique characteristics including variations in brain wave patterns, eye movements, and muscle tone. Circadian rhythms, the daily rhythms in physiology and behavior, regulate the sleep-wake cycle.

Sleep stages

Usually sleepers pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. These stages progress cyclically from 1 through REM then begin again with stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. The first sleep cycles each night have relatively short REM sleeps and long periods of deep sleep but later in the night, REM periods lengthen and deep sleep time decreases.

Stage 1

Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and muscle activity slows. During this stage, many people experience sudden muscle contractions preceded by a sensation of falling.

Stage 2

eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves

Stage 3

 extremely slow brain waves called delta waves are interspersed with smaller, faster waves

Stage 4

The brain produces delta waves almost exclusively. Stages 3 and 4 are referred to as deep sleep or delta sleep, and it is very difficult to wake someone from them. In deep sleep, there is no eye movement or muscle activity. This is when some children experience bedwetting, sleepwalking or night terrors. In 2008 the sleep profession in the US eliminated the use of stage 4. Stages 3 and 4 are now considered stage 3

REM stage

In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, and the body loses some of the ability to regulate its temperature.

REM :Cont’d

This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night.

Categories of sleep disorders

There are four major categories of sleep disorders according to the Sleep Disorders Classification Committee of the American Academy of Sleep Medicine:

1. Disorders of initiating and maintaining sleep(insomnias).2. Disorders of the sleep–wake cycle.3. Dysfunctions associated with sleep, sleep stages, orpartial arousals (parasomnias).4. Disorders of excessive somnolence.

Insomnia

difficulty falling asleep ormaintaining sleep

Predisposing factors

A*The predisposing factors for insomnia are related to the internal stressresponse mechanisms of the awakening system. They include—the hyperactivity of the hypothalamic-pituitary-adrenal axis, abnormalities in the circadian rhythm or internal clock regulating circadian sleep wakefulness, depression, and anxiety.

B*Biologicala) Ageb) Female genderc) Hormonal factors such a melatonind) Hyper arousal influences

Predisposing factors : cont’d

Precipitating factors

a. Precipitating factors of insomnia are associated with social cues, behavioral response to the environment and individual cognitive characteristics. Examples of precipitating factors include:i. Conditions affecting sleep which may include pain and discomfort that affects sleep and energy levelsii. Medications that affect sleepiii. Change in sleep environment including noise levels, lighting,temperature, and setting, which may alter sleepiv. Rotating work schedulesb. Psychological stressors also contribute to precipitating factors andresponse.

Assessment of Insomnia

B*evaluations of the sleep environment and sleep hygiene.

A*complete medical, psychological, and social Assessment.

Interventions

A*Cognitive behavior therapy (CBT) for acute and chronic insomnia provided by psychiatric clinical nurse specialist, or psychologist is the gold standard treatment for insomnia

B*The use of pharmacological agents may also benefit both acute and chronic types of insomnia

**hypnotic drugs, which induce sleep.**Other medications are also used for their sedating side effects such as anti-psychotics

General sleep Habits recommendations

• Emphasis placed on maintaining a regular sleep schedule 7 days per week during the night to promote rest for the patient & the family• Encourage gentle, regular, stretching, exercise as tolerated. Do not exercise 2-3 hours before bed.• Suggestions to create a calm environment○ Ensure a quiet & dark sleep room as preferred. Encourage use of earplugs or head phones○ Employ white noise (e.g., sound machines, fans, MP3 player, radio with soothing music or sounds)○ Refrain from watching television in bed, especially prior to sleep○ Avoid alcohol, nicotine, & caffeine later in the day & evening

If unable to fall asleep within 30 minutes of going to bed, assess for pain &/or other symptoms & treat appropriately to promote sleep such as extra pre-bedtime dosing of medications or oxygen therapy. Also if pain & other symptoms awaken the patient during regular sleeping hours, attempt a plan to decrease episodes. For example, switch to long-acting medications for stable symptoms

General sleep Habits recommendations

Disorders of the sleep-wake cycle

Disorders of the sleep-wake cycle are characterized by a temporal discrepancy of the circadian clock relative to the surrounding environmental .This may arise due to changes in external cues, as in jet lag and shift-work sleep disorder. Equally it can originate because of an abnormality in the timing of the body clock, the result of which is typically chronic insomnia.

Sleep hygiene

‘Sleep hygiene’ is the term used to describe good sleep habits.Considerable research has gone into developing a set ofguidelines and tips which are designed to enhance goodsleeping, and there is much evidence to suggest that thesestrategies can provide long-term solutions to sleep difficulties.

Sleep hygiene tips

1*Get regular.2* Sleep when sleepy.3* Get up & try again.4* Avoid caffeine & nicotine.5* Bed is for sleeping.6* No naps.7* Sleep rituals.8* Bathtime.9* No clock-watching.10* Use a sleep diary.11* Exercise.

Sleep hygiene tips : Cont’d

12*Eat right.13*The right space.14*Keep daytime routine the same.

By :Manal Abul-Haijaraghad NaseemGhadeer odeh