• 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".
• Adenosine is created over the course of the
day; high levels of adenosine lead to
• 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
• "Short sleep has been shown to be a risk factor for
weight gain, hypertension, and Type 2 diabetes,
sometimes leading to mortality;
• 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 involves a sequence of physiological
state,maintained by CNS activity that is associated
with changes in endocrine, cardiovascular,res:
• Control and regulation of sleep may depend on the
two cerebral mechanism that activate and supress
brain’s higher centre to control sleep &
• One mechanism cause sleep & other cause
• 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
Sleep assessment questionnaire:
How could a doctor evaluate my sleeping
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):
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
5. Did you snore loudly?
6. Did you hold your breath, have breathing pauses, or
stop breathing in your sleep?
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
11. Did you feel sad or anxious?
Functions of sleep:
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.
NREM sleep mauy be an anabolic state
marked by physiological process of growth
& muscular & skeletal system.Wakefulness
may be viewed as a cyclical,Hyperactive
• 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.
• 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 &
• 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
• 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 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
• Decreased physical activity
• Inability to assume usual sleep position
• Unfamiliar envt
• Frequent interruptions
Signs & symptoms of SPD
• Difficulty falling asleep or remaining asleep.
• Awakening earlier than desired
• Dozing during the day
• Difficulty concentrating
• Physical signs, i.e.,dark circles under
• 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
Classification of sleep disorder:
• Sleep disorder have been classified in to 4
• SD associated with medical,psychiatric
• Proposed sleep disorders
It’s chaecterised by either hypersomnolence
or insomnia.There are 3 major
• Disterbences of circadian rhythm
• Arousal disorders:
• Sleep walking (somnambulism)
• Sleep terrors
• Sleep-wake transition disorders:
• Sleep talking (sominoguy)
• Nocturnal leg cramps
• Associated with REM sleep:
• REM sleep behavior disorder
• Sleep paralysis
• Other parasomnias:
• Sleep bruxism (teeth grinding)
• sleep sex (sexomia)
• Sleep enuresis
SD associated with medical
• Associated with psychiatric disorder:
• Mood disorder,Anxiety disorders,
• Associated with neurological disorders:
Central degenerative disorders
• Associated with other medical disorders:
• Nocturnal cardiac ischemia, COPD,
• A slep deprivation is a problem many clients
experiences as a result of dyssomnia.
• Emotional stress,medications,envtal
disterbencess ( frequent nursing care) &
variability in the timing of sleep due to shift
• Physician & nurses are prone to sleep
deprivation due to long work schedules &
Measures to improve sleep:
• Follow an evening ritual
• Establish a regular bed time
• Engage in relaxing activities such as warm
• Use relaxation techniques
• Eliminate excess noise in the room
• Have adequate heat & blankets for warmth
• Create a dark,quite envt,& reduce
• 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
• Avoid worrying about not sleeping
• Go to bed only when sleepy
• Exercise regularly
• Keep follow-up appointments with
General principles of tx:
• Treatments for sleep disorders generally can
be grouped into four categories:
-behavioral/ psychotherapeutic treatments
-other somatic treatments
• 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
• Medications and somatic treatments may provide
the most rapid symptomatic relief from some sleep
• Narcolepsy, are best treated pharmacologically.
• Chronic and primary insomnia, may be more
amenable to behavioral interventions, with more
• Effective treatment begins with careful diagnosis
using sleep diaries and perhaps sleep studies.
Modifications in sleep hygiene may resolve the
Nsg measures in hospital settings:
• Close doors to a client room.
• Reduce volume of telephone.
• Avoid bed side equipments that is not in
• Turn off TV or radio.
• Conduct disscussion in separate room.
• Encourage the client to wear loose,fitting
• Position &and keep bed linen clean & dry
• Offer a massage just before bed time.
• Encourage the client to void before going to
• Administer analgesics or sedatives about 30
min before bed time.