Sleep and sleep disorders

Sleep and sleep disorders

1. SLEEP DISTURBANCES Presenter: Aruna Shastri Msc Nursing 1 st year

2. introduction Proper rest and sleep are as important as good nutrition and adequate exercise for a good health. Different individuals need different amounts of sleep and rest. Physical and emotional health depends on ability to fulfill these basic needs. Without proper amounts of rest and sleep, the ability to concentrate, make judgments, and participate in daily activities decreases and irritability increases.

3. SLEEP Sleep is a state of rest accompanied by altered state of consciousness from which a person can be aroused by sensory or other stimuli. It is a complex rhythmic state involving a progression of repeated cycles, each representing different phases of body and brain activity . Sleep-wake cycle influences behavioural & physiological responses in an individual.

4. PHYSIOLOGY OF SLEEP

5. PHYSIOLOGY OF SLEEP

6. PHYSIOLOGY OF SLEEP( contd …

7. Circadian rhythm 24 hr, day-night cycle/ diurnal cycle The neural basis - the suprachiasmatic nuclei This sleep wake cycle is affected by light, temp. and external factors like social activities, work routine.

8. CONTIUED….. The biological rhythm of sleep frequently becomes synchronized with other body functions. So the fluctuation and predictability of body temperature, heart rate, BP, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24hr circadian cycle.

9. Effect Of Disturbed Circadian Cycle Can be disturbed due to various factors. Causes interruption in sleep and prevent from falling asleep at usual time and can result in poor quality of sleep. Reversals in sleep wake cycle such as falling asleep during day(or vice versa for people who work nights) can indicate a serious illness.

10. Stages Of Sleep Normal sleep involves two phases : Non rapid eye movement (NREM)sleep Rapid eye movement(REM) sleep the term coined in 1952 by Fredrick Van Eeden

11. EEG WAVES

12. STAGES OF SLEEP PRESLEEP PERIOD.. In this person is aware of a gradually developing sleepiness. Normally lasts for 10 to 30 minutes. LIGHT SLEEP, NREM STAGE 1 and 2 DEEP SLEEP, NREM STAGE 3 and 4 REM The quality of sleep becomes increasingly deep.

13. STAGES OF SLEEP NREM SLEEP lasts about four to six hours restore and rebuild the body after a long period of wakefulness superficial dreams occur less likely to involve visual images and are more frequently forgotten. No rapid eye movement REM SLEEP Lasts two hours a night Processing of information, problem solving, memory consolidation and creativity. real dreams occur wild fluctuations in body metabolism Bursts of rapid eye movements

14. NREM Stage 1 Lightest level of sleep. Lasts a few minutes. 2-5% of sleep time Transition from alpha waves to theta waves. physiological activity begins to decrease. Gradual fall in vital signs and metabolism and conscious awareness of the external environment Person is aroused easily. Involuntary muscle jerking may occur

15. NREM Stage 2 Period of sound sleep. 45% to 55% of total sleep in adults Body functions continue to slow Relaxation progresses Conscious awareness of the external environment disappears Arousal remains relatively easy. Stage lasts 10 to 20 minutes.

16. NREM Stage 3 Involves initial stages of deep sleep / slow wave sleep . Muscles are completely relaxed. Sleeper is difficult to arouse and rarely moves. Vital signs decline but remain regular. Stage lasts 15 to 30 minutes.

17. NREM Stage 4 Deepest stage of sleep called “delta sleep” Very difficult to arouse sleeper. Lasts 15 to 30 minutes. Growth hormone reaches peak levels in stage 4 Usually appears only in the first 1/3 of the sleep episode Sleepwalking, nocturnal enuresis, night terrors may occur.

18. REM SLEEP 20%–25% of total sleep time. Vivid, full color dreaming may occur Stage usually begins 90 minutes after sleep has begun Duration increases with each cycle and averages 20 mints. Loss of muscle tone occurs Fluctuation in heart rate &BP occurs. Very difficult to arouse sleeper.

19. With each successive cycle, stages 3 and 4 shorten and the period of REM lengthens. The amount of time spent in each stage varies over the life span. NEWBORNS and CHILDREN spend more time in deep sleep. With AGEING sleep becomes fragmented and more time is spent in lighter stages. Shifts to light sleep or wakefulness from deep sleep tend to occur suddenly and vice versa.

20. Functions of sleep Restores physiological and psychological function NREM sleep body conserves energy. Biological functions slow in this stage. NREM sleep contributes to body tissue restoration

21. During NREM stage 4 sleep, body release growth hormone. Further protein synthesis and cell division occur during the rest and sleep. SO NREM sleep especially important for children. REM SLEEP is essential for brain tissue or cognitive restoration. Assist with memory storage and learing .

22. Effects Of Disturbed Sleep Anxiety, restlessness, irritability and impaired judgment - common symptoms Affects somatic  growth & decreased appetite loss of weight Weakening of immune system Increase in perception of pain Loss of REM sleep can lead to feelings of confusion and suspicion.

23. Effects Of Disturbed Sleep Decreased performance and alertness Memory and cognitive impairment Stress relationships Poor quality of life Occupational injury Automobile injury Depression

24. Sleep requirements and patterns Newborn sleeps 15-18 hours in one 24 hour day.   Approximately 50% is REM Sleep.

25. Sleep requirements and patterns Toddlers  require two naps, one in the morning and another in the afternoon.  Toddlers are sleeping a total of 13 or 14 hours per day Percentage of REM Sleep falls May be unwilling to go to bed at night may be due to need for 4 autonomy or fear of separation from parents. .

26. Sleep requirements and patterns Children under age of 5 years: 10 to 12 hrs of sleep is required.

27. Sleep requirements and patterns adoloscent-8 to 10 hrs

28. Sleep Requirements And Patterns Adult: 7-8 hrs Pregnant ladies: 8-10 hrs Elderly: 5-7 hrs

29. Factors affecting sleep… Drugs and substances.. eg Hypnotics- interfere with reaching deep stages. Diuretics- nightime awakening due to nocturia Antidepressants & stimulants- suppress REM sleep Anticonvulsants- decrease REM sleep time. Beta adrenergic blockers- cause insomina , nightmares, awakening from sleep. Alcohol- speeds onset of sleep, awakening during night, difficulty returning to sleep. Caffeine- prevents from falling asleep.

30. Lifestyle- rotating shifts,heavy work, late night social activities, changing evening mealtime. Unsual sleep patterns- sleep deprivation due to active social evening or lenghtened work schedule. Emotional stress Environment Exercise and fatigue Food and calorie intake Illness

31. Factors Affecting Sleep

32. DREAMS Dreaming is the perceived experience of sensory images and sounds during sleep, in a sequence which the dreamer usually perceives more as an apparent participant than as an observer. Stimulated by the  pons . Mostly occurs during the REM phase of sleep

33. DREAMS Analysis of dreams is used as a part of psychotherapy. Content of dreams Personal experiences from the last day or week are frequently incorporated into dreams. Emotions Sex themes Recurring dreams Color Vs black & white

34. SLEEP DISORDERS

35. Classification Of Sleep Disorders Disorders of initiating & maintaining sleep (DIMS) Eg : insomnia , sleep wake schedule disorders: Cataplexy, sleep apnea, JLS, SWSD. Disorders of excessive somnolence (DOES) Eg : narcolepsy Parasomnia Somnambulism, somniloquy , sleep taking, enuresis, SIDS.

36. Sleep laboratory studies Nocturnal polysomnogram Multiple sleep latency test Actigraphy Unobtrusive videotaping

37. Disorders Of Initiating & Maintaining Sleep (DIMS) Difficulty in falling asleep Early morning awakenings Waking during night May have transient / persistent pattern An association with mental illness/ use of or withdrawal from drugs including alcohol/ and medical illness

38. Insomnia Chronic difficulty falling asleep, intermittent sleep, or early awakening from sleep. Most common sleep related complaint High risk for: Individuals older than 60 years of age, having chronic pain, menopausal & pregnant women, and persons with a history of depression Occurs more frequently in women and is women’s most common sleep problem( National Sleep Foundation)

39. Insomnia contd … Causes Stress…situational stress leads to transient insomnia. age poor sleep habits pain situations involving some change in normal environment jet lag medications & substance abuse Clinical manifestations Tiredness, lethargy, and irritabiliy during the day. Difficulty concentrating Depression Hypersomnia- condition characterized by excessive sleep, particularly during the day.

40. Insomnia contd … Transient or intermittent- treatment is unnecessary Chronic insomnia- lasts > 3weeks and may continue lifelong Cause- depression, behavioral factors

41. Insomnia Treatment Chronotherapy – Behavioral technique in which bedtime is systematically delayed each day until the desired bedtime is reached . Later on a rigid bedtime & morning rising schedule is maintained. Phototherapy / bright light therapy – in patients with delayed sleep phase-exposure to bright light on awakening

42. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia Objective To assess the efficacy of moderate aerobic physical activity with  sleep hygiene and education regarding improving   sleep , mood and quality of life in older adults with chronic insomnia. Methods Seventeen sedentary adults aged ⩾55 years with insomnia (mean age 61.6 [SD ± 4.3] years; 16 female) participated in a randomized controlled trial comparing 16 weeks of aerobic physical activity plus  sleep hygiene  to non-physical activity plus  sleep hygiene

43. RESEARCH INPUT contnd … Results The physical activity group improved in  sleep  quality on the global PSQI ( p  < .0001),  sleep  latency ( p  = .049),  sleep  duration ( p  = .04), daytime dysfunction ( p  = .027), and  sleep  efficiency ( p  = .036) PSQI sub-scores compared to the control group. Conclusion Aerobic physical activity with  sleep hygiene is an effective treatment approach to improve  sleep quality , mood and quality of life in older adults with chronic insomnia.

44. Sleep- Wake Schedule Disorders Cataplexy: Is a sudden and transient episode of muscular weakness or hypotonia caused by reduced levels of nerutransmitter hypocretin . Triggered by emotions like anger, fear, surprise. Person falls into deepest stage of REM sleep immediately and without warning Duration of attack: few seconds upto 10 minutes. Clinical feautres knee or leg buckling, jaw sagging, & head drooping Slurred speech impaired vision (double vision, inability to focus) hearing and awareness remain normal.

45. 2. Sleep Apnea lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep lasts from a few seconds to minutes May occur 5 to 30 times or more an hour. Symptoms Excessive daytime sleepiness -primary symptom. snoring, snorting, and gasping sounds while sleeping Restless or unrefreshing sleep and headaches in the morning Diagnosed with a  polysomnogram or a "sleep study".

46. Pathophysiology of sleep apnea

47. 2. Sleep Apnea Three forms:  Obstructive (OSA) Most common type. Occurs when muscles or structures of oral cavity or throat relax during sleep. Common symptoms- loud snoring, restless sleep, and sleepiness during the daytime Types Mild Chronic

48. Predisposing factors: Structural abnormalities Deviated nasal septum Nasal polyp Certain jaw configurations Enlarged tonsils.

49. COMPLICATIONS OF OSA

50. 2. Sleep Apnea contd …. Central ( csa ): Central respiratory drive is absent. Cheyne -stokes respiration No breath is taken. Airway stays open, diaphragm and chest muscles stop working Seen in clients with brain stem injury, muscular dystrophy, and encephalitis. Complex or mixed sleep apnea Starts as brief periods of CSA and becomes OSA

51. Sleep Apnea contd … Diagnostic studies Assessment: oral cavity Pulmonary function test Multiple sleep latency test(MSLT) Nocturnal polysomnography (NPSG ) Treatment Treatment of underlying cause. Sleep hygiene , sleeping at low fowlers position, lateral position

52. 2. Sleep Apnea - treatment Over night sleep study to assess the severity of apnea. Oral appliances to keep the airway open during sleep. Continuous positive airway pressure (CPAP) at night Treat the underlying cardiac or respiratory complications and emotional symptoms that arise as a result of this disorder. Severe-tonsil, uvula, portion of soft palate removed surgically

53. 3. Jet Lag Syndrome is a physiological condition which results from alterations to the body's circadian rhythms due to rapid long-distance trans meridian (east-west or west-east) travel on a jet plane. symptoms Headaches, fatigue Irregular sleep patterns, insomnia Disorientation, grogginess Irritability Mild depression Constipation or diarrhea

54. JLS… CONTND ……… Before the flight Take plenty of rest, exercise and follow a healthy diet.   During the flight To avoid dehydration, avoid taking alcoholic beverages and caffeine Drink plenty of water inside the plane Exercise legs while sitting and move around the plane when the seat belt sign is switched off, every hour or two.

55. JLS… CONTND ……… Another option is to break the trip into smaller segments if it is too long and stay overnight in some city. Adjust sleeping hours on the plane to match the destination time. Upon arrival Adapt to the local time and eat accordingly. Also, exposure to sunlight during the day is helpful.

56. 4. Shift work sleep disorder (SWSD) a circadian rhythm sleep disorder which affects people who change their work or sleep schedules frequently or who work long term on other than day hours. recurrent interruption of sleep patterns may result in insomnia and/or excessive sleepiness

57. Health risks associated with night shifts: trasversal study in a sample of nurses at the Cassino hospital This transversal study , by means of a self-administered questionnaire, evaluated the incidence of mental and physical problems in 58 nurses at the "Santa Scolastica " Hospital in Cassino to identify the principal factors responsible for sleep disturbances and to implement preventive strategies

58. RESEARCH INPUT contnd …. Results showed that in many cases disturbances were attributable to lack of rest . Shorter and more irregular sleep  was associated with age and amount of working years, together with poor organizational capacities : irregular shifts , upbringing of children and family burdens aggravated this situation . For nurses, night work can have a negative influence not only on the quality of care and the incidence of accidents and errors but also affect their private life and health.

59. DISORDERS OF EXCESSIVE SLEEP: Narcolepsy Disorder of excessive somnolence Sudden sleep attack. REM may occur within 15 minutes of falling asleep If cataleptic attack is severe the client may lose voluntary muscle control and may fall to the floor. Reaches REM sleep within 15 minutes.

60. Excessive sleepiness during the day is often the first symptom of narcolepsy. Sleep paralysis: feeling of being unable to move or talk just before waking or falling asleep, is another symptom. Vivid dreams, visual & auditory hallucinations may occur at the onset of sleep Significant problem with narcolepsy is that person falls asleep uncontrollably at inappropriate times.

61. Narcolepsy Nervous system disorder Believed that narcolepsy is caused by reduced amounts of a protein called hypocretin , which is made in the brain. Narcolepsy tends to run in families No known cure A CNS stimulant(methylphenidate) that causes wakefulness is used to control narcolepsy Others like wakefulness promoting agent- modafinil .

62. Other management methods: Brief daytime naps no longer than 20 minutes may help to remove subjective feelings of sleepiness. Regular exercise program Eating light meals high in protein Practicising deep breathing Chewing gum Taking vitamins Avoiding factors that increase drowsiness like alcohol, heavy metals, exhausting activities, long distance driving, long periods of sitting etc.

63. Restless leg syndrome Unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs. Sensation may occur anywhere from ankle to thigh Kicking or twitching leg movements during sleep, and sometimes while awake – primary warning signs. Usually feels better if you get up to walk around or rub your leg.

64. Restless leg syndrome Causes N ot known. In middle-aged and older adults. Stress Heriditary RLS may occur more often in patients with: Peripheral neuropathy Chronic kidney disease Parkinson's disease Pregnancy Iron deficiency No known cure

65. MANAGEMENT: NON PHARMACOLOGICAL MEASURES. Rest less leg syndrome aimed at reducing stress and helping the muscles relax Warm baths Gentle stretching exercises Massage Eliminate use of caffeine, tobacco, and alcohol. Take a mild analgesic at bedtime Use antiembolism stockings at the onset of symptoms

66. Parasomnias Parasomnias are patterns of waking behavior that appear during sleep Examples are- somnambulism, sleeptalking , bruxism, enuresis, sudden infant death sydrome . More commonly seen in children Difficult to arouse patient during episode and have poor recall of events in the morning when fully awake.

67. Night terror Person quickly awakens from sleep in a terrified state. Causes The cause is unknown May be triggered by fever, lack of sleep, or periods of emotional tension, stress, or conflict. Night terrors may run in families. They can occur in adults, especially with emotional tension and/or the use of alcohol. Night terrors are most common in boys ages 5 - 7, although they also can occur in girls.

68. Symptoms – night terror Occurs during deep sleep,at the midnight(~2am) Children scream ,frightened and confused,may thrash around violently and are unaware of surroundings . Unable to talk to, comfort, or fully awaken a child who is having a night terror. sweating , hyperventilation,   fast HR, and dilated pupils May last 10 - 20 min, then normal sleep returns. Most children unable to explain what happened the next morning. May also sleep walk

69. Night terror contd … Prognosis Most children outgrow night terrors in a short period of time. Prevention Minimizing stress or using coping mechanisms may reduce night terrors. The number of episodes usually decreases after age Possible Complications - insomnia 

70. Somnambulism / Sleep Walk Occurs when a person walks or does another activity while they are still asleep. Most often occurs during deep, non-rem sleep (stage 3 or stage 4 sleep) early in the night. Cause unknown. Fatigue, lack of sleep, and anxiety are all associated with sleepwalking.

71. Somnambulism In adults, sleepwalking may be associated with : Mental disorders Reactions to drugs and alcohol Medical conditions such as partial complex seizures In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders. can occur at any age, most often in children aged 4 - 8. It appears to run in families.

72. Sleep walk- Symptoms Sleeping while driving The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer. If not disturbed, sleepwalkers will go back to sleep. Eyes open during sleep May have blank look on face Not remembering the sleep walking episode when they wake up Acting confused or disoriented when they wake up Rarely, shows aggressiveness when they are awakened by someone else

73. Somnambulism Contd … Treatment Most people don't need any specific treatment for sleepwalking. Safety measures may be needed to prevent injury.(moving objects such as electrical cords or furniture to reduce the chances of tripping and falling, blocking off stairways with a gate. Short-acting tranquilizers – reduces sleepwalking episodes.

74. Sleep Walk contd … Complications Risk for injury while sleepwalking Prevention Avoid the use of alcohol or central nervous system depressants if you sleepwalk. Avoid getting too tired, stress and try to prevent insomnia because this can trigger a sleepwalking episode.

75. Nocturnal Leg Cramps Sudden, involuntary contractions most commonly of the calf muscles during the night or periods of rest. The cramps are painful and may last upto ten minutes. There might also be soreness after the cramp goes away. More in middle-aged or older populations.

76. Nocturnal Leg Cramps Triggering events - prolonged sitting, dehydration, an overexertion of the muscles , or structural disorders (such as flat feet). Have also been linked to certain conditions like diabetes,PVD , parkinsons disease. Muscle-stretching, exercise, and adequate water intake may help prevent leg cramps.

77. Sleep Talking Talk that occurs during sleep can be brief and involve simple sounds, or it can involve long speeches by the sleeper. person typically has no recollection of the actions. Causes - fever, emotional stress, or other sleep disorder

78. Sleep Paralysis not able to move their body or limbs either when falling asleep or waking up. Brief episodes of partial or complete skeletal muscle paralysis Cause unknown:can be hereditary An episode of sleep paralysis often is terminated by sound or touch. Within minutes, the person with sleep paralysis is able to move again. It may occur only once in your lifetime or can be a recurrent phenomenon.

79. Sudden infant death syndrome Sudden and unexplained death of infant. Referred to as cot death or crib death. Exact casue unknown. RISK FACTORS: sleeping in prone position tobacco smoking in mother. genetic factors. Preventive strategies: well ventilated room, sleeping in supine position, giving pacifiers etc.

80. Enuresis or bed wetting Involuntary urination while asleep after the age at which bladder control usually occurs. Is acquired by age of three years. Enuresis may be primary or secondary. Treatment measures include restriction of fluid after 8pm, bladder training during daytime,supportive psychotherapy and pharmacotherapy: imimpramine . Protect and promote self esteem of the child.

81. Snoring More frequent in men and people who are overweight. worsens with age. Occasional snoring is usually not very serious and is mostly a nuisance for your bed partner. What causes snoring? Obstructed nasal airways Poor muscle tone in the throat and tongue Bulky throat tissue Long soft palate and/or uvula

82. Snoring( contnd …..

83. Snoring contd … Health Risks Associated With Snoring Long interruptions of breathing (more than 10 seconds) during sleep caused by partial or total obstruction or blockage of the airway. Frequent waking from sleep Light sleeping Strain on the heart.  Poor night's sleep

84. Teeth Grinding (Sleep Bruxism) Teeth can be damaged and other complications can arise, such as jaw muscle discomfort. CAUSES Causes unknown Stressful situations, an abnormal bite, and crooked or missing teeth are some of the reasons. PREVENTION Mouth guard Stress reduction and other lifestyle modifications, including the avoidance of alcohol and caffeine Relax your jaw muscles at night by holding a warm washcloth against your cheek in front of your earlobe

85. Teeth Grinding – preventive measures contd Train yourself not to clench or grind your teeth. If you notice that you clench or grind during the day, position the tip of your tongue between your teeth. This practice trains your jaw muscles to relax . Do not chew on pencils or pens or anything that is not food. Avoid chewing gum as it allows your jaw muscles to get more used to clenching and makes you more likely to grind your teeth.

86. MANAGEMENT

87. Pharmacological management Insomnia & night terror short term use of sedative hypnotics- Zolpidem Antidepressants – benzodiazepines Narcolepsy CNS stimulants like methylphenidate 5 – 100 mg/day, modafinil ( provigil ) 200 – 800 mg/day Tricyclic antidepressants & SSRIs Sodium oxybate – improves sleep quality in patients Jet lag Melatonin supplements Melatonin Receptor Stimulant – Rozerem Short-acting benzodiazepines such as Xanax Nonbenzodiazepine Hypnotics - Ambien, Sonata, Lunesta

88. Pharmacological management of restless leg syndrome Low doses of pramipexole or ropinirole ( requip ) –dopaminergic agents- controlling symptoms If sleep is severely disrupted, sinemet (an anti- parkinson's medication) Gabapentin and pregabalin Tranquilizers - clonazepam. Patients with iron deficiency will receive iron supplements. Low doses of narcotics

89. Adverse effects of hypnotics & benzodiazepines Somnolence Dizziness Ataxia Amnesia Nausea Discontinuation effects – Rebound insomnia, withdrawal syndrome, recurrence Dependence liability – Dose escalation, self-administration outside therapeutic context

90. Non Pharmacological Measures Changing unhealthy behaviors Moderate intensity exercise programs during day time Regular sleep – wake cycle Sleep restriction-avoid naps in daytime Sleep hygiene education & modification of lifestyle patterns Treat underlying cause & associated medical problems Comfort and reassurance Relaxation technique Behavioral therapy

91. Sleep Problems in Children Signs : Snoring Breathing pauses during sleep Problems with sleeping through the night Difficulty staying awake during the day Unexplained decrease in daytime performance Unusual events during sleep like night terrors,nightmares , bed wetting

92. SLEEP DISORDERS IN THE ELDERLY problems with falling or staying asleep, excessive sleep, early morning awakening, taking more daytime naps or abnormal behaviors associated with sleep.  The change is in the quality of sleep not in the quantity of sleep . Older people cannot get into the stage four sleep, which is a deep sleep.

93. SLEEP DISORDERS IN THE ELDERLY Causes And Risk Factors A need to urinate frequently at night Chronic pain caused by diseases such as arthritis Chronic diseases such as congestive heart failure Depression Neurological conditions Alzheimer's disease Organic brain syndrome Sedentary lifestyle Stimulants such as caffeine Prescription drugs , recreational drugs, or alcohol

94. SLEEP DISORDERS IN THE ELDERLY Symptoms Difficulty falling asleep Difficulty in telling the difference between night and day Early morning awakening Waking up frequently during the night Signs And Tests Patient's history of  sleep  disturbances & contributing factors. Physical examination to rule out medical causes.

95. Sleep disorders in the elderly Treatment The relief of chronic pain and control of underlying medical conditions such as frequent urination  Effective treatment of depression Sleep hygiene Avoid use of sleeping pills to promote sleep on a long-term basis since it can lead to dependence and worsening sleep problems over time

96. Sleep disorders in the elderly Eg :   ambien  and  lunesta  are relatively safe when used properly. It is best to not take sleeping pills on consecutive days or for more than 2 - 4 days a week. Alcohol can make the side effects of all sleeping pills worse and should be avoided. Prognosis Most people see improvement in sleep with treatment or interventions. However, others may continue to have persistent sleep disruptions.

97. Supports & Resources American Academy of Sleep Medicine American Sleep Association National Sleep Foundation  Narcolepsy Network National Center for Sleep Disorders Research  Restless Legs Syndrome Foundation

98. Sleep clinic AIIMS the FIRST sleep clinic and sleep laboratory and developed the 'state-of art' Clinical Neurophysiology Laboratory under the Neurology services since 2001 an average of 200 patients with different types of sleep disorders are managed annually. 

99. Nursing assessment Sleep history- nature of the problem Its cause Related signs and symptoms When it first began and how often it occurs How it affects everyday living Severity of problem How patient is coping with the problem

100. Cont … Sleep diary A graph of the total number of hours of sleep per day A daily record of patient’s sleep patterns, behaviors, foods, worry, anxiety etc. Physical assessment: key findings are- Diminished energy level Facial characteristics Behavioral characteristics Snoring Nocturnal myoclonus

101. Nursing diagnosis Sleep pattern disturbances related to ;use of or withdrawal from, substances; anxiety or depression; circadian rhythm disruption; familial patterns; evidenced by insomnia, hypersomnia, nightmares, sleep terrors, or sleep walking. Risk for injury related to excessive sleepiness, sleep tremors, or sleep walking.

102. Nursing interventions Promoting sleep/sleep hygeine The promotion of regular sleep is known as sleep hygiene. Maintain a regular bedtime and arising time.  Develop a ‘going to bed' routine. This pre-bedtime routine should include relaxation and soothing activities. Wear comfortable, loose-fitting clothing Get adequate exposure to bright light during the day. Go outside and enjoy the day.

103. Sleep hygiene contd … Eat a balanced diet with regular mealtimes.  Eat a light meal for dinner Eat a light carbohydrate snack at bedtime if hungry Sleep in a quiet, dark, and relaxing environment, which is neither too hot nor too cold Lose weight if you are overweight. 

104. Sleep hygiene DON'T: Don't nap during the day or evening. Don't eat heavy meals or drink large amounts of liquid before bedtime. Don't dwell on intense thought or feeling before bedtime. Don't lie awake in bed for long periods of time. If not asleep within 20 or 30 minutes, leave your bedroom and do something relaxing until you fall asleep again.

105. Sleep hygiene - Don’t Don't allow your sleep to be disturbed by your phone, pets, family, etc. Don't use alcohol, caffeine, or nicotine. Make your bed comfortable and use it only for sleeping and not for other activities, such as reading, watching TV, or listening to music.

106. Nursing interventions (CONT..) PREVENTING INJURY Ensure that side rails are up on the bed Keep the bed in a low position Equip the bed with a bell that is activated when the bed is exited Keep a night light on and arrange the furniture in the bedroom in a manner that promotes safety Administer drug therapy as ordered

107. Summary Sleep Physiology of sleep Circadian rhythm Stages of sleep Sleep cycle Factors affecting sleep Dreams Sleep requirements and patterns Classification of sleep disorders Sleep laboratory studies Sleep problems in pediatric population, elderly Nursing process

108. Conclusion Sleep is a complex phenomenon. Disruption of sleep patterns can disrupt physical & mental health . A good night’s sleep is a bridge between despair and hope.

109. References Taylor C, Lillis C, LeMone P; Fundamentals of Nursing- The Art and Science of Nursing Care; fourth edition, Lippincott; page no:1013-1031 Potter P, Perry A; Fundamentals of Nursing; 6 th edition; Mosby; page no-1198-1225 Kryger,Roth,Dement,”principles & practices of sleep medicine”,2 nd edtn , Saunders,pg no:411 – 598 Ellen Barker,” Neurosceince Nursing – A Spectrum of Care”, mosby 3 rd edn ,: pg 200 - 215 Mary C Townsend,”Psychiatric Mental Health Nursing”,5 th edn,Jaypee;pg 583 - 591

110. Thank you