sleep disorder.pptx in mental health nursing

mental health and psychiatric nursing sleep disordr

1. Normal Sleep One of the most significant of human behaviors( 1/3 of human life) It is a universal behavior Use for proper functioning. Prolonged sleep deprivation impairment and, eventually, death. Sleep is particularly relevant to psychiatry.

2. ELECTROPHYSIOLOGY OF SLEEP Sleep is made up of two physiological states: Non-rapid eye movement (NREM) sleep and Rapid eye movement (REM) sleep. In NREM sleep, which is composed of stages 1 through 4, most physiological functions are markedly lower than in wakefulness. REM sleep is a qualitatively different kind of sleep (physiological activity levels similar to those in wakefulness). About 90 minutes after sleep onset, NREM yields to the first REM episode of the night.

3. Sleep is typically scored in epochs of 30 seconds, with stages of sleep defined by the visual scoring of three parameters: E lectroencephalogram (EEG) E lectro- oculogram (EOG), and E lectromyogram (EMG) recorded beneath the chin. EEG- records the rapid conjugate eye movements EOG-records eye movement and eye blinking EMG-records muscle tone

4. These sleep patterns change over a person’s life span. In the neonatal period, REM sleep represents more than 50 percent of total sleep time , Newborns sleep about 16 hours a day, with brief periods of wakefulness. By 4 months of age, the pattern shifts so that the total percentage of REM sleep drops to less than 40 percent, and entry into sleep occurs with an initial period of NREM sleep.

5. By young adulthood, the distribution of sleep stages is as follows: NREM (75 percent) Stage 1: 5 percent Stage 2: 45 percent Stage 3: 12 percent Stage 4: 13 percent REM (25 percent) This distribution remains relatively constant into old age, although a reduction occurs in both slow-wave sleep and REM sleep in older persons.

6. Sleep serves as: R estorative , Homeostatic function (thermoregulation and energy conservation). Satisfying metabolic needs .

7. Sleep-wake disorders Sleep-wake disorders encompass 10 disorders or disorder groups: insomnia disorder, hyper somnolence disorder, narcolepsy , breathing-related sleep disorders, Circadian rhythm sleep-wake disorders, non-rapid eye movement (NREM) sleep arousal disorders ,

8. 7. nightmare disorder, 8. rapid eye movement (REM) sleep behavior disorder, 9. restless legs syndrome, 10. substance/medication-induced sleep disorder. Problem with quality , timing , and amount of sleep.

9. INSOMNIA DISORDER Insomnia is defined as difficulty initiating or maintaining sleep. It is the most common sleep complaint and may be transient or persistent. One year prevalence rate of 30-45% adults . It is associated with sleep quantity or quality problem with one or more of the following symptoms: D ifficulty in initiating sleep, maintaining sleep with frequent awakenings or problems returning to sleep, and early morning awakening with inability to return to sleep.

10. Sleep state misperception - subjective insomnia , is characterized by a dissociation between the patient’s experience of sleeping and the objective poly graphic measures of sleep.

11. Insomnia Disorder A. A predominant complaint of dissatisfaction witli sleep quantity or quality, associated with one (or more) of the following symptoms: 1 . Difficulty initiating sleep (in children, difficulty without caregiver) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, difficulty without caregiver) 3. Early-morning awakening with inability to return to sleep. B. Clinically significant distress or impairment

12. C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. The sleep difficulty occurs despite adequate opportunity for sleep. F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder. G. The insomnia is not attributable to the physiological effects of a substance H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. Specify if: With non-sleep disorder mental co morbidity, including substance use disorders With other medical co morbidity With other sleep disorder

13. Rx Insomnia Primary insomnia is commonly treated with benzodiazepines Hypnotic drugs should be used with care. Middle night insomnia :- flurazepam ( Dalmane ), quazepam (Doral) difficulty falling asleep:- zolpidem , triazolam ( Halcion ) . S leep-onset insomnia :- The melatonin-receptor agonist - Ramelteon ( Rozerem ). Example of BDZs alprazolam  ( Xanax ,  Xanax XR ) clobazam  ( Onfi ) clonazepam  ( Klonopin ) clorazepate  ( Tranxene ) chlordiazepoxide  ( Librium ) diazepam  ( Valium ) lorazepam  ( Ativan ) oxazepam  ( Serax ) temazepam  ( Restoril ) triazolam  ( Halcion )

14. Psychotherapy: CBT??? Universal sleep hygiene- read it and it will be on exam!!!