PRESENTAION ON

SLEEP PATTERNS DISTURBANCE

PRESENTED BY:- RAKESH

M.SC NURSING 2ND SEM
ACON,AUH
 CONTENT:-
 Definition
 Physiology of sleep
 Stages of sleep
 Sleep requirements and patterns
 Factors affecting sleep
 Life span consideration
 Sleep disorders
 Assessment of patients with sleep disorders
 Role of nurse
 Conclusion
SLEEP PATTERNS DISTURBANCE:-
• DEFINITION:- Sleep is a naturally recurring
state of mind characterized by altered
consciousness relatively inhibited sensory
activity, inhibition of nearly all voluntary
muscles, and reduced interactions with
surroundings
PHYSIOLOGY OF SLEEP :-
 Reticular activating system (RAS) and bulbar
synchronizing region controls cyclic nature of
sleep

 During sleep RAS experiences few stimuli

from the cerebral cortex and the periphery of
the body
 Wakefulness occurs when this system is activated
with stimuli from the cerebral cortex and from
periphery sensory organs and cells

 Norepinephrine and acetylcholine, in addition to

dopamine, serotonin and histamine are involved with
excitation

 Gamma amino butyric acid (GABA) appears to be

necessary for inhibition
STAGES OF SLEEP:-

 non rapid eye movement (NREM) sleep

 rapid eye movement (REM) sleep

NREM SLEEP:-
 NREM sleep (comprising about 75% of total
sleep) consists of four stages
 Stage 1 and stage 2 consuming about 5% and 50%
of a person’s sleep time, respectively, are light
sleep
 Stage 3 and 4 each representing about 10% of
total sleep time, are deep sleep stages, termed
delta sleep or slow wave sleep
STAGE 1 CHARACTERISTICS :-
 Transitional stage between wakefulness and sleep
 A relaxed
 Involuntary muscle jerking
 Stage normally lasts only minutes
 Can be aroused easily
 Constitutes only about 5% of total sleep
STAGE 2:-
 person falls into a stage of sleep
 can be aroused with relative case
 constitutes 50% to 55% of sleep
STAGE 3:-
 depth of sleep increase and arousal becomes
increasingly
 composes about 10% of sleep
STAGE 4:-
 reaches the greatest depth of sleep
 aroused from sleep is difficult
 physiologic changes in the body
REM SLEEP:-
 it is more difficult to arouse a person during REM
sleep than during NREM sleep
 in normal adults, the REM state consumes 20% to
25% of a persons nightly sleep time
 people who are awakened during the REM state
almost always report that they have been dreaming
 a person who is deprived of REM sleep for
several nights generally than spend more time in
REM sleep on successive nights, this
phenomenon termed REM rebound allows the
total amount of REM sleep to remain fairly
constant over time
CHARACTERISTICS :-
 eyes dart back and forth quickly (nystagmus)
 small muscle twitching such as on the face
 large muscle immobility, resembling paralysis
 respirations irregular- sometimes interspersed
with apnoea
 rapid or irregular pulse
 blood pressure increases of fluctuates
 increase in gastric secretions
 metabolism increases , body temperature increases
 encephalogram tracings active
 REM sleep enters from stage 2 of NREM sleep and re
enters, NREM sleep at stage 2 , arousal from sleep difficult
 Constitutes of about 20% to 25% of sleep
SLEEP REQUIREMENTS AND PATTERN:-
 8 hours of sleep at night has been the accepted
standard for adults
 On the average, infants require 14 to 20 hours
each day
 Growing children require from 10-14 hours of
sleep
 For adults is 7 to 9 hours
 Sleep pattern for older adults vary
 Patterns of sleep periodicity appear to be learned
FACTORS AFFECTING SLEEP:-
 Development considerations
 Motivation
 Culture
 Lifestyle habits
 Environment factors
 Psychological stress
LIFE SPAN CONSIDERATIONS:-
• NEW BORNS AND INFANTS:-
- Sleeps an average of 16 hours/ 24 hours
- Usually by 8 to 16 weeks of age, an infant sleeps
through the night
- REM sleep constitutes much of the sleep cycle of
a young infant
TODDLERS:-
 May initially sleep 12 hours at night with two naps
during the day and end this stage sleeping 8 to 10
at night and napping once during the day
 Begin to resist naps and going to bed at night
PRESCHOOLARS:-
 Sleep 9 to 16 hours at night with 12 hours being
the average
 The REM sleep pattern is similar to that of an
adult
 Daytime napping decreases
 This age group may continue to resist going to bed
at night
SCHOOL AGED CHILDREN:-
 10-12 hours of sleep
 Sleep needs usually increase when physical
growth peaks
ADOLESCENTS:-
 The growth spurt that normally occurs at this stage
may necessitate the need for more sleep
 Many adolescents do not get enough sleep
YOUNG ADULTS:-
 Average amount of sleep required is 8 hours
 Sleep is affected by many factors, physical health,
type of occupation, lifestyle etc.
 REM sleep average about 20% of sleep
OLDER ADULTS:-
 Average of 5-7 hours of sleep
 Sleep is less sound and stage 4 sleep is absent or
considerably decreased, periods of REM sleep
shorten
 Elderly people frequently have great difficulty
falling asleep and have more complaints of
problems sleeping
SLEEP DISORDERS:-
 DYSSOMNIAS :- they are sleep disorders
characterized by insomnias or excessive
sleepiness
 PARASOMNIAS:- They are patterns of waking
behaviour that appear during sleep
INSOMNIA:-
 Insomnia is difficulty falling asleep or staying
asleep, even when a person has the chance to do
so
Based on its duration it is classified as:-
• ACUTE INSOMNIA:- It is brief and often
happens because of life circumstances
• CHRONIC INSOMNIA:- is disrupted sleep that
occurs at least three nights per week and lasts at
least three months
CAUSES:-
 Insomnia can be caused by psychiatric and medical
conditions unhealthy sleep habits specific substances
and certain biological factors
 Sinus
 Gastrointestinal problem
 Endocrine problems such as hyperthyroidism
 Arthritis
 Asthma
 Neurological conditions such as Parkinson disease
 Low back pain
SYMPTOMS:-
 Difficulty falling asleep
 Waking up too early in the morning
 Fatigue or low energy
 Cognitive impairment
 Mood disturbance
 Behaviour problems
 Difficulty at work or school
 Difficulty in personal relationships
TREATMENT:-
 Non medical (cognitive and behavioural)
treatment for insomnia
 There are psychological and behavioural
techniques that can be helpful for treating
insomnia
 Relaxation training or progressive muscle
relaxation teaches the person to systematically
tense and relax muscles in different areas of the
body
 Stimulus control helps to build an association between the
bedroom and sleep by limiting the type of activities allowed in
the bedroom

 Cognitive behavioural therapy includes behavioural changes

 Major classes of prescription insomnia medications include

benzodiazepine hypnotics, non benzodiazepines hypnotics and
melatonin receptor agonists
HYPERSOMNIA:-
 It is a sleep related disorder that causes excessive
daytime sleepiness in people, often regardless of the
presence of other sleeping disorders, or poor sleep
hygiene
 People with hypersomnia will often sleep in excess of
10 hours
 Hypersomnia is a relatively rare sleeping disorder,
affecting under 1% of the population. It is slightly more
common in females than in males, and typically starts
in early adulthood. It is very rarely found in children
DIAGNOSIS:-
 Polysomnogram and multiple sleep latency tests are both
good tools in detecting hypersomnia and other sleeping
disorders
 The multiple sleep latency test measures the speed at which a
person enters deep sleep over numerous 2 hour intervals
 People with hypersomnia and other related disorders like
narcolepsy tend to fall asleep very quickly, and this is
considered the best test for detected these sleeping disorders
 The polysomnogram test measures the subject’s brain waves
and bodily movements during sleep phases, and this is good
for detecting other sleep disorders that may be leading to the
daytime sleepiness
TREATMENT:-
 Hypersomnia is most commonly treated with
stimulants like amphetamine and modafinil
 Antidepressants, behavioural changes are also
instituted in most cases, and for those with
idiopathic hypersomnia, this is one of the only
treatment methods available at present
 Proper sleep hygiene is the most important
behavioural change that must be implemented
NARCOLEPSY:-
 It is neurological disorder caused by the brain’s inability
to regulate sleep wake cycles normally
 The main features of narcolepsy are fatigue and catalepsy
 Its prevalence in the developed world is approximately the
same as that of multiple sclerosis or Parkinson's disease
 Despite the perception that people with narcolepsy are
perpetually sleepy, they do not typically sleep more than
the average person
 Narcolepsy is considered a state boundary control
abnormality
SYMPTOMS:-
The main symptoms associated with narcolepsy are:-
 Excessive daytime sleepiness
 Cataplexy
 Hypnogogic hallucinations
 Disturbed nocturnal sleep
 Leg jerks, nightmares and restlessness
TREATMENT:-
 Treatment for narcolepsy includes the use of
medication as well as behavioural therapy
 Behavioural therapies
 Counselling
 Antidepressants are also often used to treat cataplexy,
hypnagogic hallucinations and sleep paralysis
 Sodium oxybate, a strong sleep inducing agent may
be given at night to improve disturbed nocturnal
sleep and reduce daytime sleepiness and cataplexy
SLEEP APNEA:-
 Obstructive sleep apnoea is a sleep disorder in
which breathing is briefly and repeatedly
interrupted during sleep
 Obstructive sleep apnoea occurs when the
muscles in the back of the throat fail to keep the
airway open, despite efforts to breathe
SYMPTOMS:-
 Chronic snoring
 Difficulty concentrating
 Depression, irritability
 Sexual dysfunction
 Learning and memory difficulties
 Falling asleep while at work
 On the phone or driving
TREATMENT:-
 The treatment of choice for obstructive sleep apnoea
is continuous positive airway pressure device (CPAP)
 Second line methods of treating sleep apnoea include
dental appliances which reposition the lower jaw and
tongue and upper airway surgery to remove tissue in
the airway. In general these approaches are most
helpful for mild disease or heavy snoring
 Lose weight
 Avoid alcohol
 Quit smoking
RESTLESS LEGS SYNDROME (RLS):-
 Restless legs syndrome also known as Willis
Ekbom disease is a neurologic sensorimotor
disorder that is characterized by an overwhelming
urge to move the legs when they are at rest
 The urge to move the legs is usually but not
always accompanied by unpleasant sensations
 RLS symptoms occur during inactivity and they
are temporarily relieved by movement or pressure
CAUSES:-
 The exact cause of RLS is unknown
 Primary RLS:- is the most common type of RLS.
It is also referred to as familial (because it is
hereditary) or idiopathic (because the causes are
unknown) RLS
 Secondary RLS:- on the other hand is believed to
be caused by a separate underlying medical
condition or in association with the use of certain
drugs
SYMPTOMS:-
 The urge to move the legs is usually but not
always accompanied by unpleasant sensations
 The symptoms of restless legs syndrome are often
difficult to put into words as each person’s
experience with RLS is different. Some people
use comparisons such as like ants crawling
through my legs or like soda running through my
veins to try to describe the symptoms and feelings
TREATMENT:-
 Lifestyle changes
 Underlying iron or vitamin deficiency
 Healthy and balanced
 Gabapentin enacarbil was approved by the FDA
in 2011 for the treatment of moderate to severe
primary RLS
 Mirapex was approved by the FDA in 2006 for the
treatment of moderate to severe primary RLS
HOME REMEDIES:-
 Walking
 Massaging the legs
 Stretching
 Hot or cold packs
 Vibration
 Acupressure
 Practicing relaxation techniques such as meditation
or yoga have been known to alleviate symptoms
SLEEP DEPRIVATION:-

 Sleep deprivation occurs when an individual fails

to get enough sleep
CAUSES:-
 Voluntary behaviour people who engage in
voluntary but unintentional chronic sleep
deprivation are classified as having a sleep
disorder called behavioural induced insufficient
sleep syndrome
 Work hours
 Personal obligations
SYMPTOMS:-
 Mood
 Irritability
 Lack of motivation
 Anxiety
 Symptoms of depression
 Performance
 Lack of concentration
 Attention deficits
 Reduced vigilance
 Longer reaction times
 Distractibility
 Lack of energy
 Fatigue
 Restlessness
 Lack of coordination
 Forgetfulness
TREATMENT:-
 The only sure way for an individual to overcome
sleep deprivation is to increase nightly sleep time
to satisfy his or her biological sleep need there is
no substitute for sufficient sleep
PARASOMNIAS:-
 The term parasomnia refers to all the abnormal
things that can happen to people while they sleep,
apart from sleep apnoea
 Parasomnias can occur as a person is falling asleep
or at any point in the sleep cycle
 Sleep paralysis can be quite frightening especially
when it occurs with hallucinations
 Some examples are sleep related eating disorder sleep
waking nightmares, sleep paralysis, REM sleep behaviour
disorder and sleep aggression, sex somnia, sometimes
called sleep sex is also a parasomnia. It refers to sexual acts
that are carried out by a person who is sleeping.
Parasomnias can have negative effects on people during the
daytime, including sleepiness
ASSESSMENT OF PATIENTS WITH SLEEP DISORDERS:-
 Usual sleep
 Time of sleeping and waking time
 Number of hours of undisturbed sleep
 Quality of sleep
 No. of naps
 Effect on daily chores
 Energy level
 Means of relaxing before bedtime
 Bedtime rituals
 Sleep environment
 Pharmacological aids
 Nature of sleep disturbance
 Onset
 Causes
 Severity
 Symptoms
 Intervention attempted and its result
ROLE OF NURSE:-
 The nurse will assess the patients sleeping pattern and help him develop
a sleeping plan – the nurse will provide a dark, quiet and comfortable
atmosphere for the patient to sleep in
 The nurse will discourage caffeine or large meal intake 2 hrs before the
patient goes to sleep
 The nurse will educate the patient on techniques on how to fall sleep
and stay asleep
 observe and obtain feedbacks regarding on the usual sleeping pattern,
bedtime routine and the usual number of hours of sleep and rest
 do as much care as possible without waking up the client and do as
much care as possible while the client is still awake
 provide active meaningful activities during daytime hours, including
exposure to natural light, and an outdoor environment when possible
 monitor frequency and duration of naps
 Promoting bedtime rituals that includes a quieting activity
a light carbohydrate snack going to the bathroom and
settling a routine
 Offering appropriate bedtime snacks and beverages
 Promoting relaxation
 Promoting comfort
 Respecting normal sleep patterns
 Scheduling nursing care to avoid unnecessary disturbances
 Using medication to produce sleep
 Teaching about rest sleep
 Preparing a restful environment
 Discourage long periods of sleep during the day unless signs and symptoms of
sleep deprivation exist or daytime sleep is usual for client
 Perform actions to relieve discomfort if present (eg. Reposition client,
administer prescribed analgesic, anti-emetics or muscle relaxants
 Offer client an evening snack that includes milk or cheese unless
contraindicated (the L- tryptophan in milk and cheese helps induce and
maintain sleep)
 Encourage client to urinate just before bedtime
 Ensure good room ventilation
 Encourage client to avoid drinking alcohol in the evening ( alcohol interferes
with REM sleep)
 If possible, administer medications that can interfere with sleep (eg. Steroids,
diuretics) early in the day rather than late afternoon or evening
 Administer prescribed sedative hypnotics if indicated
 Consult appropriate health care provider if signs and symptoms of sleep
deprivation persist or worsen
CONCLUSION:-
• Sleep is a cyclical physiological process that
alternates with longer periods of wakefulness. The
sleep wake cycle influences and regulates
physiological function and behavioural responses.
Circadian rhythms influences the pattern of major
biological and behavioural functions. The
fluctuation and predictability of body temperature,
heart rate, blood pressure, hormone secretion,
sensory acuity and mood depend on the
maintenance of the 24 hrs circadian cycle
• MULTIPLE CHOICE QUESTION:-
1.Nightmares occur in:
A.REM sleep
B.NREM- 1 sleep
C.NREM- 2 sleep
D.NREM – 3 sleep

2. How many stages comprise Non- REM sleep?

E.6
F. 1
G.5
H.3
I. 4
J. 2
3. The non REM sleep is commonly associated with
A.Frequent dreaming
B.Frequent penile erections
C.Increased blood pressure
D.Night terror

4. Cataplexy is seen in
E. Narcoplexy
F. Neuroleptic malignant syndrome
G.Catatonic schizophrenia
d. Chronic depression
DESCRIPTIVE QUESTIONS:-
1.Explain about the physiology of sleep?
2.Discuss about different stages of sleep?
3.what is parasomnia?
4.Explain about the nursing role in sleep patterns
disturbance?