SLEEP PATTERN DISTERBENCE

MS.SASIKALA,

MSC.NURSING 1ST YEAR

Sleep:

• Sleep is a cyclical physiological process that alternates with longer period of wakefulness by decreased ability to react to stimuli

Physiology of sleep:

• The sleep wake cycle influences and regulates the physiological & behavioural response.

STAGES OF SLEEP

SLEEP CYCLE

Timing:

• Sleep timing is controlled by the circadian clock sleep-wake homeostasis, and in humans, within certain bounds, willed behavior.

• A circadian rhythm is a roughly 24-hour cycle in the biochemical, physiological, or behavioural processes of living entities.

• The term "circadian" comes from the Latin circa, "around", and diem or dies, "day", meaning literally "approximately one day".

Cont…..

• Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness.

• The release of the hormone melatonin and a gradual decrease in core body temperature.

• Sleep offset awakening is primarily determined by circadian rhythm.

Optimal amount in human:

• Researchers at the University of Warwick and University College London have found that lack of sleep can more than double the risk of death from cardiovascular disease, but that too much sleep can also be associated with a doubling of the risk of death, though not primarily from cardiovascular disease.

• "Short sleep has been shown to be a risk factor for weight gain, hypertension, and Type 2 diabetes, sometimes leading to mortality;

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• sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder.

• Up to 90% of adults with depression are found to have sleep difficulties.

Hours by age:Age and condition Average amount of sleep per day

Newborn up to 18 hours

1–12 months 14–18 hours

1–3 years 12–15 hours

3–5 years 11–13 hours

5–12 years 9–11 hours

Adolescents 9–10 hours

Adults, including elderly 7–8(+) hours

Pregnant women 8(+) hours

Sleep regulation:

• Sleep involves a sequence of physiological state,maintained by CNS activity that is associated with changes in endocrine, cardiovascular,res: &muscular system.

• Control and regulation of sleep may depend on the two cerebral mechanism that activate and supress brain’s higher centre to control sleep & walkefulness.

• One mechanism cause sleep & other cause wakefulness.

Cont…

• The ascending reticular activating system located in upper brain stem is belived that maintain alertness & walkefulness.

• Sleep may be produced by release of seretonin from pond’s & medulla.this area is also called as bulbar synchronizing region.

Sleep assessment questionnaire:

• Question: How could a doctor evaluate my sleeping problems?

• Answer: A rather simple screening test might help your doctor to evaluate a possible sleeping disorder. Here is a list of 11 questions (Global Sleep Assessment Questionnaire GSAQ):

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1. Did you have difficulty falling asleep, staying asleep, or did you feel poorly rested in the morning?

2. Did you fall asleep unintentionally or did you have to fight to stay awake during the day?

3. Did sleep difficulties or daytime sleepiness interfere with your daily activities?

4. Did work or other activities prevent you from getting enough sleep?

5. Did you snore loudly?6. Did you hold your breath, have breathing pauses, or

stop breathing in your sleep?

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7. Did you have restless or "crawling" feelings in your legs at night that went away if you moved your legs?

8. Did you have repeated rhythmic leg jerks or leg twitches during your sleep?

9. Did you have nightmares, or did you scream, walk, punch, or kick in your sleep?

10. Did the following things disturb you in your sleep: pain, other physical symptoms, worries, medications, or other (specify)?

11. Did you feel sad or anxious?

Functions of sleep:

• Preservation During sleep the heart rate falls to 60

b/mts or less,this means that the heart beats 10 to 20 fewer times in each minite during sleep or 60 to 120 fewer times in each hour. Clearly restful sleep preserve cardiac function.other biological function decreased during sleep or resp,BP,muscle tone.

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• Anabolic/Catabolic:

NREM sleep mauy be an anabolic state marked by physiological process of growth & muscular & skeletal system.Wakefulness may be viewed as a cyclical,Hyperactive catabolic state.

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• Memory processing: Scientists have shown numerous ways in

which sleep is related to memory.In a study working memory was shown to be affected by sleep deprivation.Working memory is important because it keeps information activity for furthur processing.Cognitive functions such as decision making,reasoning & episodic memory.

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• Restoration:• REM is needed for brain tissue restoration &

appears to be important for cognitive restoration.REM sleep is asociated with changes in cerebral blood flow,Increased cortical activites,Increased oxygen consumption & epinephrine release.This association may assist with memory storage & learning.

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• Coserve energy: Body conserves energy during sleep.

The skeletal muscles relax progressively,& the absence of muscles contraction preserves chemical energy for cellular processces. Lowering of basal metabolic rate further conserve the energy supply

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• Dreaming:• Dreaming is the perception of sensory

images & sounds during sleep,in a sequence which the dreamer usually perceives more as an apparent participant than an observer. Dreaming is stimulated by the pons & mostly occurs during the REM phase of sleep.

Sleep pattern disturbance:

• Sleep pattern disturbance is the state in which an individual experiences a disruption of sleep time that causes dizscomfort or interferes with disired lifestyle.

Possible causes:

• Decreased physical activity• Fear,anxiety,stress,depression• Inability to assume usual sleep position• Unfamiliar envt• Frequent interruptions• Medications• Illnesses• Hyperactivity• Pain

Signs & symptoms of SPD

• Difficulty falling asleep or remaining asleep.• Awakening earlier than desired• Dozing during the day• Agitation,irritability• Lethargy,Lislessness• Fatigue• Difficulty concentrating• Disorientation• Physical signs, i.e.,dark circles under

eyes,yawning,slurred speech

Sleep disorder:

• SD(sominopathy) is a medical disorder of the sleep pattern of a person. Some SDare serious enough to interfere with normal physical mental & emotional functioning.

• Test used for some SD is the polysomnography.

Pediatric polysomnography:

Classification of sleep disorder:

• Sleep disorder have been classified in to 4 major categories.

• Dyssomnias

• Parasomnias

• SD associated with medical,psychiatric disorders.

• Proposed sleep disorders

Cond…

• Dyssomnias

It’s chaecterised by either hypersomnolence or insomnia.There are 3 major subcatagories includes

• Intrinsic

• Extrinsic

• Disterbences of circadian rhythm

Dyssomnia:• Intrinsic sleep disorders:

• Insomnia • Narcolepsy• Periodic limb movement disorders• Sleep apnea syndromes

• Extinsic sleep disorders:• Inadequate sleep hygiene• Insufficient syndrome• Hypnotic dependent sleep disordrs• Alcohol-dependent sleep disorders

• Circadian rhythm sleep disorders:• Time zone change syndrome• Shift work sleep disorder• Delayed sleep phase syndrome

Parasomnias:

• Arousal disorders:• Sleep walking (somnambulism)• Sleep terrors

• Sleep-wake transition disorders:• Sleep talking (sominoguy)• Nocturnal leg cramps

• Associated with REM sleep:• Nightmares• REM sleep behavior disorder• Sleep paralysis

• Other parasomnias:• Sleep bruxism (teeth grinding)• sleep sex (sexomia)• Sleep enuresis

SD associated with medical psychiatric disorders:• Associated with psychiatric disorder:

• Mood disorder,Anxiety disorders, Psychoses,Alcoholism

• Associated with neurological disorders:• Dementia,Parkinsonism, Central

degenerative disorders• Associated with other medical disorders:

• Nocturnal cardiac ischemia, COPD, Peptic ulcer

Proposed sleep disorders:

• Menstruation associated SD

• Sleep choking syndrome

• Pregnancy associated sleep disorders

Sleep deprivation:

• A slep deprivation is a problem many clients experiences as a result of dyssomnia.

• Causes:• Emotional stress,medications,envtal disterbencess

( frequent nursing care) & variability in the timing of sleep due to shift work.

• Physician & nurses are prone to sleep deprivation due to long work schedules & rotating shift.

Factors affecting sleep:

• Drugs & substancess• Lifestyle • Usual sleep patterns • Emotional stress• Envt• Exercise & fatigue• Food & caloric intake• Motivation• Illness

Measures to improve sleep:

• Follow an evening ritual• Establish a regular bed time• Engage in relaxing activities such as warm

baths,backrubs,soft music,etc.• Use relaxation techniques• Eliminate excess noise in the room• Have adequate heat & blankets for warmth• Create a dark,quite envt,& reduce distractions

Cont…

• Take pain medication as needed

• Avoid afternoon naps

• Avoid cafeine,i.e.,coffee,tea,chocolate,cola

• Avod spicy fods

• Avoid eating before bed time

• Avoid sleeping medications unless absolutely necessary

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• Avoid worrying about not sleeping

• Go to bed only when sleepy

• Exercise regularly

• Keep follow-up appointments with physician

General principles of tx:

• Treatments for sleep disorders generally can be grouped into four categories:

-behavioral/ psychotherapeutic treatments -rehabilitation/management

-medications -other somatic treatments

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• General approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history.

• Behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits.

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• Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances.

• Narcolepsy, are best treated pharmacologically.• Chronic and primary insomnia, may be more

amenable to behavioral interventions, with more durable results.

• Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem .

Nsg measures in hospital settings:

• Close doors to a client room.• Reduce volume of telephone.• Avoid bed side equipments that is not in

use. • Turn off TV or radio.• Conduct disscussion in separate room.• Encourage the client to wear loose,fitting

night dress.

Cont …

• Position &and keep bed linen clean & dry

• Offer a massage just before bed time.

• Encourage the client to void before going to sleep.

• Administer analgesics or sedatives about 30 min before bed time.

RESEARCH STUDIES:

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