SLEEP AS A BASIC PHYSIOLOGICAL NEED.pptx

SLEEP AS A BASIC PHYSIOLOGICAL NEED.pptx

1. SLEEP

2. PHYSIOLOGY OF SLEEP Sleep is a cyclic physiological process that alternates with longer periods of wakefulness. The sleep- wake cycle influences and regulates physiological function and behavioral responses. People experience Cyclical rhythm as a part of their everyday lives. The most familiar rhythm is the 24 hour, day night cycle known as Diurnal or Circadian rhythm .

3. Cont… The suprachiasmatic nucleus nerve cells in the hypothalamus control the rhythm of sleep wake cycle and coordinates this cycle with circadian rhythms. Circadian rhythm influence the pattern of major biological and behavioral functions. The predictable change in body temperature, blood pressure, sensory acuity and mood depends on maintenance of 24 hr circadian cycle.

4. Cont… Factors such as light, temperature, social activities, work routines affect circadian rhythm and daily sleep wake cycles. All people have biological clock the synchronize their sleep cycles. The biological rhythm of sleep becomes synchronized with other body functions. When the sleep wake cycle becomes disrupted, other physiological functions changes. Failure to maintain sleep wake cycle influence the patient’s overall health.

5. SLEEP REGULATION Sleep involves a sequence of physiological states maintained by highly integrated central nervous system activity. It is associated with changes in the peripheral nervous , endocrine, cardio vascular , respiratory, muscular system. The major sleep center in the body is hypothalamus. It secretes hypo cretins that promote wakefulness and rapid eye movement sleep.

6. Cont… Prostaglandin D2, L- tryptophan and growth factors control sleep. Arousal, wakefulness and maintenance of consciousness result from neurons in the reticular activating system located in upper brain stem. The homeostatic process regulates the length and depth of sleep and the circadian rhythm influence the internal organization of sleep and time , duration of sleep wake cycle.

7. STAGES OF SLEEP STAGE-I (NREM) Stage lasts a few minutes. It includes lightest level of sleep. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Sensory stimuli such as – noise easily arouse person. When awakened, person feels as though day dreaming has occurred.

8. Cont… STAGE-II (NREM) Stage lasts 10 to 20 minutes. It is a period of sound sleep. Relaxation progresses. Body functions continue to slow. Arousal remains relatively easy.

9. Cont… STAGE-III (NREM) Stage lasts 15 to 20 minutes. It involves initial stages of deep sleep. Muscles are completely relaxed. Vital signs decline but remain regular. Sleeper is difficult to arouse and rarely moves.

10. Cont…. STAGE-IV ( NREM) Stage lasts approximately 15 to 30 minutes. It is the deepest stage of sleep. If sleep loss has occurred, sleeper spends considerable part of night in this stage. Vital signs are significantly lower than during waking hours. Sleepwalking and enuresis sometimes occur. It is very difficult to arouse sleeper.

11. Cont… REM SLEEP Stage usually begins about 90 minutes after sleep has begun. Duration increase with each sleep cycle and average 20 minutes. Vivid, full color dreaming occurs, less vivid dreaming occurs in other stage. Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increase or fluctuating BP , loss of muscle tone, increase of gastric secretion. It is very difficult to arouse sleeper.

12. SLEEP CYCLE NREM-I NREM-II NREM-III NREM-IV REM NREM-II NREM-III

13. CONT….. The normal sleep pattern for an adult begins with a pre sleep period where the person is only of a gradually developing sleepiness. The person usually passes through 4 or 5 complete sleep cycles per night, each consists of 4 stages of NREM and a period of REM sleep. Each cycle lasts approximately 90 to 100 minutes. The cyclic pattern usually progress from stage I through stage IV of NREM, followed by a reversal from 4 to 3 to2, ending with a period of REM sleep. No. of sleep cycle depends on total amount of time a person spends sleeping.

14. FACTORS AFFECTING SLEEP Drugs and substances- sleep deprivation Life style- daily routine influence sleep pattern. Excessive day time sleepiness- impairment in waking function, poor work and school performance. Emotional stress- worry over personal problem and situation can disrupt sleep. Environment- influence the ability to fall and remain sleep. condition and position of bed, light temperature and home environment influence sleep.

15. Cont…. Exercise and fatigue- usually achieve restful sleep. Excess fatigue resulting from exhausting or stressful work can make falling asleep difficult. Food and caloric intake- people sleep better in healthy state. Eating habit is important for proper sleep. Eating large ,heavy or spicy meal at night result in indigestion interferes with sleep. caffeine and coffee intake in evening causes insomnia.

16. SLEEP DISORDERS INSOMNIA- It is a symptom that patient experience when they have chronic difficulty in falling asleep, frequent awakening from sleep or short sleep or non restorative sleep. It is most common sleep related complain and common in women. Patient experience EDS and insufficient sleep quantity and quality. It often signals underlying physical and psychological problem.

17. Cont…. Transient insomnia as a result of situational stress like- family, work , school problem, jet lag , illness, loss of loved one. Insomnia is often associated with poor sleep hygiene. During the day, the patient with insomnia feel sleepy, fatigued, depressed and anxious. Treatment is symptomatic including improve sleep hygiene, biofeedback, cognitive and relaxation technique.

18. SLEEP APNEA Sleep apnea is a disorder characterized by the lack of air flow through the nose and mouth for periods of 10 seconds or longer during sleep. Three types- central, Obstructive and mixed apnea. Obstructive apnea is common ,caused by obesity, hypertension. Smoking, heart failure, T2DM, Alcohol, positive family history increase the risk. It occurs when muscles or structure of oral cavity or throat relax during sleep.

19. CONT.. Upper airway becomes partially or completely blocked, diminishing nasal airflow( hypopnea ) Or stopping it (apnea). The person still attempts to breath because chest and abdominal movement continue, results in loud snoring. Structural abnormalities such as deviated septum, nasal polyp, jaw configuration, larger neck circumference, enlarged tonsils can cause OSA. OSA has the potential to contribute high BP, increase risk of heart attack and stroke, decline in arterial O2 saturation.

20. CONT… Central apnea involves dysfunction in the respiratory control center of the brain. The impulse to breath fails temporarily, nasal air flow and chest wall movement cease. The O2 saturation of the blood falls . This condition is common in patients with brainstem injury, muscular dystrophy, encephalitis People with CSA tend to awaken during sleep and therefore complain insomnia. mild and intermittent snoring.

21. Cont… Patients with sleep apnea rarely achieve deep sleep. Complain of EDS, sleep attack, fatigue, morning headache, irritability, depression, difficulty in concentration and interfere daily life. Treatment includes therapy for underlying cardiac and respiratory complaints and emotional problem.

22. NARCOLEPSY Narcolepsy is a dysfunction of mechanism that regulate sleep and wake state. EDS is most common complaint associated with this disorder. During the day a person suddenly feel an overwhelming wave of sleepiness and falls asleep, REM sleep occurs within 15 minutes. Cataplexy or sudden muscle weakness during intense emotion such as anger, sadness or laughter occurs at any time of the day . If severe, patient losses voluntary muscle control and falls to the floor.

23. Cont… A patient with narcolepsy has vivid dream. These dreams are difficult to distinguish from reality. Sleep paralysis or feeling of unable to move or talk just before waking or falling asleep, is another symptom. A person with narcolepsy falls asleep uncontrollably at appropriate time which often mistaken by laziness, lack of interest in activities or drunkenness Typically symptom begin to appear in adolescence and often confused with EDS that commonly occur in teens.

24. Cont… Treated with stimulants or wakefulness promoting agents such as- sodium oxybate , modafinil , armodafinil . Increase the wakefulness and reduce sleep attack. Antidepressant suppress cataplexy . Brief day time nap ( not more than 20 min) can reduce subjective feeling of sleepiness. Other management includes- regular exercise, brief day time nap, light meal with protein, practicing deep breathing, chewing gum and taking vitamins. Need to avoid factors increase drowsiness ( alcohol, heavy meal, exhausting activities, long distance driving long periods of sitting in hot stuffy room

25. SLEEP DEPRIVATION Sleep deprivation is a problem many patients experience as a result of dyssomnia . Causes includes symptoms ( pain ,fever, breathing difficulty) , emotional stress, medication, environmental disturbances, shift work. Chronic sleep deprivation is associated with development of cardiovascular disease, weight gain, T2DM, poor memory, depression, digestive problem .

26. Cont…. Physiological symptoms are ptosis (dropping of eyelid), blurred vision, fine motor clumsiness, decreased reflexes, slowed response time, decrease reasoning and judgment. decrease auditory and visual alertness, cardiac arrhythmias. Psychological symptoms includes confused, disoriented, increase sensitivity to pain, irritable, withdrawn, apathetic, agitated, hyperactive, decrease motivation, excessive sleepiness.

27. PARASOMNIAS Disruptive sleep disorder occur during arousal from REM sleep or arousal from NREM sleep. More common in children than adults. Parasomnias that occur among children include somnambulism ( sleep walking), night terrors, night mares, nocturnal enuresis ( bed wetting), body rocking bruxism (teeth grinding). Treatment varies. support patients and maintain their safety.