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Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
Sleep Disorders2
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Sleep Disorders2

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  1. LEEP DISORDERS Ma. Tosca Cybil A. Torres, RN
  2. Key Terms <ul><li>Apnea: The temporary absence of breathing. Sleep apnea consists of repeated episodes of temporary suspension of breathing during sleep. </li></ul><ul><li>Cataplexy: Sudden loss of muscle tone (often causing a person to fall), usually triggered by intense emotion. It is regarded as a diagnostic sign of narcolepsy. </li></ul><ul><li>Circadian rhythm: Any body rhythm that recurs in 24-hour cycles. The sleep-wake cycle is an example of a circadian rhythm. </li></ul><ul><li>Dyssomnia: A primary sleep disorder in which the patient suffers from changes in the quantity, quality, or timing of sleep. </li></ul><ul><li>Electroencephalogram (EEG): The record obtained by a device that measures electrical impulses in the brain. </li></ul><ul><li>Hypersomnia: An abnormal increase of 25% or more in time spent sleeping. Patients usually have excessive daytime sleepiness. </li></ul><ul><li>Hypnotic: A medication that makes a person sleep. </li></ul><ul><li>Hypopnea: Shallow or excessively slow breathing usually caused by partial closure of the upper airway during sleep, leading to disruption of sleep. </li></ul><ul><li>Insomnia: Difficulty in falling asleep or remaining asleep. </li></ul><ul><li>Jet lag: A temporary disruption of the body's sleep-wake rhythm following high-speed air travel across several time zones. Jet lag is most severe in people who have crossed eight or more time zones in 24 hours. </li></ul><ul><li>Kleine-Levin syndrome: A disorder that occurs primarily in young males, three or four times a year. The syndrome is marked by episodes of hypersomnia, hypersexual behavior, and excessive eating. </li></ul>
  3. <ul><li>Narcolepsy: A life-long sleep disorder marked by four symptoms: sudden brief sleep attacks, cataplexy, temporary paralysis, and hallucinations. The hallucinations are associated with falling asleep or the transition from sleeping to waking. </li></ul><ul><li>Nocturnal myoclonus : A disorder in which the patient is awakened repeatedly during the night by cramps or twitches in the calf muscles. Nocturnal myoclonus is sometimes called periodic limb movement disorder (PLMD). </li></ul><ul><li>Non-rapid eye movement (NREM) sleep: A type of sleep that differs from rapid eye movement (REM) sleep. The four stages of NREM sleep account for 75-80% of total sleeping time. </li></ul><ul><li>Parasomnia: A primary sleep disorder in which the person's physiology or behaviors are affected by sleep, the sleep stage, or the transition from sleeping to waking. </li></ul><ul><li>Pavor nocturnus: Another term for sleep terror disorder. </li></ul><ul><li>Polysomnography: Laboratory measurement of a patient's basic physiological processes during sleep. Polysomnography usually measures eye movement, brain waves, and muscular tension. </li></ul><ul><li>Primary sleep disorder: A sleep disorder that cannot be attributed to a medical condition, another mental disorder, or prescription medications or other substances. </li></ul><ul><li>Rapid eye movement (REM) sleep: A phase of sleep during which the person's eyes move rapidly beneath the lids. It accounts for 20-25% of sleep time. Dreaming occurs during REM sleep. </li></ul><ul><li>REM latency: After a person falls asleep, the amount of time it takes for the first onset of REM sleep. </li></ul><ul><li>Restless legs syndrome (RLS): A disorder in which the patient experiences crawling, aching, or other disagreeable sensations in the calves that can be relieved by movement. RLS is a frequent cause of difficulty falling asleep at night. </li></ul><ul><li>Sedative: A medication given to calm agitated patients; sometimes used as a synonym for hypnotic. </li></ul><ul><li>Sleep latency: The amount of time that it takes to fall asleep. Sleep latency is measured in minutes and is important in diagnosing depression. </li></ul><ul><li>Somnambulism: Another term for sleepwalking. </li></ul>
  4. What is Sleep? <ul><li>Sleep is a physical and mental resting state in which a person becomes relatively inactive and unaware of the environment. In essence, sleep is a partial detachment from the world, where most external stimuli are blocked from the senses. </li></ul>
  5. <ul><li>Normal sleep is characterized by a general decrease in body temperature, blood pressure, breathing rate, and most other bodily functions. In contrast, the human brain never decreases inactivity. Studies have shown that the brain is as active during sleep as it is when awake. Throughout an eight-hour sleep cycle, a normal adult alternates between two very different states, non-REM and REM (Rapid Eye Movement) sleep. </li></ul>
  6. Five Stages of Human Sleep <ul><li>Stage 1 NREM sleep. This stage occurs while a person is falling asleep. It represents about 5% of a normal adult's sleep time. </li></ul><ul><li>Stage 2 NREM sleep. In this stage, (the beginning of &quot;true&quot; sleep), the person's electroencephalogram (EEG) will show distinctive wave forms called sleep spindles and K complexes. About 50% of sleep time is stage 2 REM sleep. </li></ul><ul><li>Stages 3 and 4 NREM sleep. Also called delta or slow wave sleep, these are the deepest levels of human sleep and represent 10-20% of sleep time. They usually occur during the first 30-50% of the sleeping period. There is a marked secretion of growth hormone in stage 4. </li></ul><ul><li>REM sleep. REM sleep makes up 20% of our sleep time and during this stage we experience vivid dreams. It usually begins about 90 minutes after the person falls asleep, an important measure called REM latency. It alternates with NREM sleep about every hour and a half throughout the night. REM periods increase in length over the course of the night. </li></ul>
  7. Hours by age Children need a greater amount of sleep per day than adults to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages.A newborn baby spends almost half of its sleep time in REM-sleep. By the age of five or so, only a bit over two hours are spent in REM.
  8. Sleep Disorder Defined: <ul><li>group of syndromes characterized by disturbance in the patient's amount of sleep, quality or timing of sleep, or in behaviors or physiological conditions associated with sleep. </li></ul><ul><li>There are about 70 different sleep disorders </li></ul><ul><li>The condition must be a persistent problem, cause the patient significant emotional distress, and interfere with his or her social or occupational functioning. </li></ul>
  9. Predisposing Factors to Sleep Disorders <ul><li>Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and sleepwalking. </li></ul><ul><li>A number of medical conditions, as well as aging have been implicated in the etiology of insomnia. </li></ul><ul><li>Psychiatric or environmental conditions that can contribute to insomnia or hypersomnia include anxiety, depression, environmental changes, circadian rhythm sleep disturbances, PTSD, and schizophrenia. </li></ul>
  10. <ul><li>Night terrors may be related to minor neurological abnormalities, particularly in the temporal lobe. </li></ul><ul><li>Episodes of sleepwalking are exacerbated by extreme fatigue and sleep deprivation. </li></ul><ul><li>Activities that interfere with 24-hour circadian rhythm of hormonal and neurotransmitter functioning within the body predispose individuals to sleep-wake schedule disturbances. </li></ul>
  11. Primary Sleep Disorders <ul><li>Primary sleep disorders are distinguished from those that are not caused by other mental disorders, prescription medications, substance abuse, or medical conditions </li></ul><ul><li>The two major categories of primary sleep disorders are dyssomnias and the parasomnias . </li></ul>
  12. Dyssomnias <ul><li>primary sleep disorders in which the patient suffers from changes in the amount, restfulness, and timing of sleep. </li></ul>
  13. Types of dyssomnias
  14. Primary Insomnia <ul><li>difficulty in falling asleep or remaining asleep that lasts for at least one month. </li></ul><ul><li>can be caused by a traumatic event related to sleep or bedtime, and it is often associated with increased physical or psychological arousal at night </li></ul><ul><li>People who experience primary insomnia are often anxious about not being able to sleep </li></ul><ul><li>usually begins when the person is a young adult or in middle age </li></ul>
  15. Diagnostic criteria for Primary Insomnia  <ul><li>The predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month.  </li></ul><ul><li>The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The sleep disturbance does not occur exclusively during the course of Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia.  </li></ul><ul><li>The disturbance does not occur exclusively during the course of another mental disorder (e.g., Major Depressive Disorder, Generalized Anxiety Disorder, a Delirium).  </li></ul><ul><li>The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. </li></ul>
  16. Primary Hypersomnia <ul><li>a condition marked by excessive sleepiness during normal waking hours. </li></ul><ul><li>The patient has either lengthy episodes of daytime sleep or episodes of daytime sleep on a daily basis even though he or she is sleeping normally at night </li></ul><ul><li>In some cases, patients with primary hypersomnia have difficulty waking in the morning and may appear confused or angry---condition is sometimes called sleep drunkenness and more common in males. </li></ul><ul><li>usually affects young adults between the ages of 15 and 30 </li></ul>
  17. Diagnostic criteria for Primary Hypersomnia  <ul><li>The predominant complaint is excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily.  </li></ul><ul><li>The excessive sleepiness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The excessive sleepiness is not better accounted for by Insomnia and does not occur exclusively during the course of another Sleep Disorder (e.g., Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia) and cannot be accounted for by an inadequate amount of sleep.  </li></ul><ul><li>The disturbance does not occur exclusively during the course of another mental disorder.  </li></ul><ul><li>The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.  </li></ul><ul><li>Specify if:  Recurrent: if there are periods of excessive sleepiness that last at least 3 days occurring several times a year for at least 2 years </li></ul>
  18. Narcolepsy <ul><li>characterized by recurrent &quot;sleep attacks&quot; that the patient cannot fight </li></ul><ul><li>The sleep attacks are about 10-20 minutes long. </li></ul><ul><li>The patient feels refreshed by the sleep, but typically feels sleepy again several hours later. </li></ul><ul><li>About 40% of patients with narcolepsy have or have had another mental disorder </li></ul><ul><li>Almost 18% of patients with narcolepsy are 10 years old or younger </li></ul><ul><li>Men and women are equally affected. </li></ul>
  19. Narcolepsy <ul><li>3 major symptoms: </li></ul><ul><li>Cataplexy is the sudden loss of muscle tone and stability (&quot;drop attacks&quot;) </li></ul><ul><li>Hallucinations may occur just before falling asleep (hypnagogic) or right after waking up (hypnopompic) and are associated with an episode of REM sleep. </li></ul><ul><li>Sleep paralysis occurs during the transition from being asleep to waking up. </li></ul>
  20. Diagnostic criteria for Narcolepsy  <ul><li>Irresistible attacks of refreshing sleep that occur daily over at least 3 months.  </li></ul><ul><li>The presence of one or both of the following:  </li></ul><ul><li>cataplexy (i.e., brief episodes of sudden bilateral loss of muscle tone, most often in association with intense emotion)  </li></ul><ul><li>recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes  </li></ul><ul><li>C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another general medical condition. </li></ul>
  21. Breathing-related Sleep Disorders <ul><li>syndromes in which the patient's sleep is interrupted by problems with his or her breathing </li></ul>
  22. 4 types of breathing-related sleep disorders: <ul><li>Obstructive sleep apnea syndrome. This is the most common form of breathing-related sleep disorder, marked by episodes of blockage in the upper airway during sleep. It is found primarily in obese people. Patients with this disorder typically alternate between periods of snoring or gasping (when their airway is partly open) and periods of silence (when their airway is blocked). Very loud snoring is a clue to this disorder. </li></ul><ul><li>Central sleep apnea syndrome. This disorder is primarily found in elderly patients with heart or neurological conditions that affect their ability to breathe properly. It is not associated with airway blockage and may be related to brain disease. </li></ul><ul><li>Central alveolar hypoventilation syndrome. This disorder is found most often in extremely obese people. The patient's airway is not blocked, but his or her blood oxygen level is too low. </li></ul><ul><li>Mixed-type sleep apnea syndrome. This disorder combines symptoms of both obstructive and central sleep apnea. </li></ul>
  23. Diagnostic criteria for Breathing-Related Sleep Disorder <ul><li>Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep-related breathing condition (e.g., obstructive or central sleep apnea syndrome or central alveolar hypoventilation syndrome).  </li></ul><ul><li>The disturbance is not better accounted for by another mental disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another general medical condition (other than a breathing-related disorder).  </li></ul><ul><li>Coding note: Also code sleep-related breathing disorder on Axis III. </li></ul>
  24. Circadian Rhythm Sleep Disorders <ul><li>results from a discrepancy between the person's daily sleep/wake patterns and demands of social activities, shift work, or travel </li></ul>
  25. Types of Circadian Rhythm Sleep Disorders
  26. Jet lag sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone 
  27. Shift work insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work 
  28. Non-24-hour sleep-wake syndrome <ul><li>rare and chronic circadian rhythm sleep disorder. </li></ul><ul><li>&quot;a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living in society.“ </li></ul><ul><li>The pattern of delay persists literally &quot;around the clock,&quot; typically taking a few weeks to complete one cycle. </li></ul><ul><li>It affects less than 0.05% of the population (fewer than 1 in 2000 people), which means that it is classified as a &quot;rare disease. </li></ul>
  29. Delayed sleep phase <ul><li>also known as delayed sleep-phase disorder (DSPD) or delayed sleep-phase type (DSPT) </li></ul><ul><li>is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, core body temperature, hormonal and other daily rhythms relative to the usual norms. </li></ul><ul><li>People with DSPS tend to fall asleep some hours after midnight and have difficulty waking up in the morning </li></ul><ul><li>usually develops in early childhood or adolescence, and sometimes disappears in adolescence or early adulthood. </li></ul>
  30. Advanced sleep phase syndrome ( ASPS ) <ul><li>also known as the advanced sleep-phase type ( ASPT ) of circadian rhythm sleep disorder </li></ul><ul><li>a condition in which patients feel very sleepy early in the evening (e.g. 18:00-19:00) and wake up very early in the morning (e.g. 03:00). </li></ul><ul><li>ASPS is frequently encountered in the elderly and in post-menopausal women. </li></ul><ul><li>It can be treated pharmacologically, with evening bright lights, or behaviorally with chronotherapy or free-running sleep </li></ul>
  31. Circadian Rhythm Sleep Disorders <ul><li>People who are ordinarily early risers appear to be more vulnerable to jet lag and shift work-related circadian rhythm disorders than people who are &quot;night owls.&quot; </li></ul><ul><li>There are some patients who do not fit the pattern of these three disorders and appear to be the opposite of the delayed sleep phase type. These patients have an advanced sleep phase pattern and cannot stay awake in the evening, but wake up on their own in the early morning. </li></ul>
  32. Diagnostic criteria for Circadian Rhythm Sleep Disorder <ul><li>  </li></ul><ul><li>A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep-wake pattern.  </li></ul><ul><li>The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The disturbance does not occur exclusively during the course of another Sleep Disorder or other mental disorder.  </li></ul><ul><li>The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.  </li></ul><ul><li>Specify type: </li></ul><ul><li>Delayed Sleep Phase Type </li></ul><ul><li>Jet Lag Type </li></ul><ul><li>Shift Work Type: </li></ul><ul><li>Unspecified Type </li></ul>
  33. PARASOMNIAS <ul><li>primary sleep disorders in which the patient's behavior is affected by specific sleep stages or transitions between sleeping and waking. They are sometimes described as disorders of physiological arousal during sleep. </li></ul>
  34. Nightmare Disorder <ul><li>a parasomnia in which the patient is repeatedly awakened from sleep by frightening dreams and is fully alert on awakening. </li></ul><ul><li>Approximately 10-50% of children between three and five years old have nightmares. </li></ul><ul><li>They occur during REM sleep, usually in the second half of the night </li></ul><ul><li>The child is usually able to remember the content of the nightmare and may be afraid to go back to sleep. </li></ul><ul><li>More females than males have this disorder, but it is not known whether the sex difference reflects a difference in occurrence or a difference in reporting. </li></ul><ul><li>Nightmare disorder is most likely to occur in children or adults under severe or traumatic stress. </li></ul>
  35. Diagnostic criteria for Nightmare Disorder  <ul><li>Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.  </li></ul><ul><li>On awakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in Sleep Terror Disorder and some forms of epilepsy).  </li></ul><ul><li>The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The nightmares do not occur exclusively during the course of another mental disorder (e.g., a Delirium, Posttraumatic Stress Disorder) and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. </li></ul>
  36. Sleep Terror Disorder <ul><li>is a parasomnia in which the patient awakens screaming or crying. </li></ul><ul><li>The patient also has physical signs of arousal, like sweating, shaking, etc. </li></ul><ul><li>It is sometimes referred to as pavor nocturnus . </li></ul><ul><li>Unlike nightmares, sleep terrors typically occur in stage 3 or stage 4 NREM sleep during the first third of the night. </li></ul><ul><li>The patient may be confused or disoriented for several minutes and cannot recall the content of the dream. </li></ul><ul><li>He or she may fall asleep again and not remember the episode the next morning. </li></ul><ul><li>Sleep terror disorder is most common in children four to 12 years old and is outgrown in adolescence. </li></ul><ul><li>It affects about 3% of children. </li></ul><ul><li>Fewer than 1% of adults have the disorder. I </li></ul><ul><li>in adults, it usually begins between the ages of 20 and 30. </li></ul><ul><li>In children, more males than females have the disorder. In adults, men and women are equally affected. </li></ul>
  37. Diagnostic criteria for Sleep Terror Disorder <ul><li>Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.  </li></ul><ul><li>Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode.  </li></ul><ul><li>Relative unresponsiveness to efforts of others to comfort the person during the episode.  </li></ul><ul><li>No detailed dream is recalled and there is amnesia for the episode.  </li></ul><ul><li>The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. </li></ul>
  38. Sleepwalking disorder <ul><li>sometimes called somnambulism </li></ul><ul><li>occurs when the patient is capable of complex movements during sleep, including walking. </li></ul><ul><li>Like sleep terror disorder, sleepwalking occurs during stage 3 and stage 4 NREM sleep during the first part of the night. </li></ul><ul><li>If the patient is awakened during a sleepwalking episode, he or she may be disoriented and have no memory of the behavior. </li></ul><ul><li>In addition to walking around, patients with sleepwalking disorder have been reported to eat, use the bathroom, unlock doors, or talk to others. It is estimated that 10-30% of children have at least one episode of sleepwalking. However, only 1-5% meet the criteria for sleepwalking disorder. </li></ul><ul><li>The disorder is most common in children eight to 12 years old. </li></ul><ul><li>It is unusual for sleepwalking to occur for the first time in adults. </li></ul>
  39. Diagnostic criteria for Sleepwalking Disorder   <ul><li>Repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of the major sleep episode.  </li></ul><ul><li>While sleepwalking, the person has a blank, staring face, is relatively unresponsive to the efforts of others to communicate with him or her, and can be awakened only with great difficulty.  </li></ul><ul><li>On awakening (either from the sleepwalking episode or the next morning), the person has amnesia for the episode.  </li></ul><ul><li>Within several minutes after awakening from the sleepwalking episode, there is no impairment of mental activity or behavior (although there may initially be a short period of confusion or disorientation).  </li></ul><ul><li>The sleepwalking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  </li></ul><ul><li>The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. </li></ul>
  40. Periodic Limb Movement Disorder <ul><li>affects people only during sleep. </li></ul><ul><li>The condition is characterized by behavior ranging from shallow, continual movement of the ankle or toes, to wild and strenuous kicking and flailing of the legs and arms. </li></ul><ul><li>Furthermore, abdominal, oral, and nasal movement sometimes accompanies PLMD. </li></ul><ul><li>Movement of the legs is more typical than movement of the arms in cases of PLMD. </li></ul><ul><li>Movements typically occur for 0.5 to 10 seconds, in intervals separated by five to 90 seconds. </li></ul><ul><li>A formal diagnosis of nocturnal myoclonus requires three periods during the night, lasting from a few minutes to an hour or more, each containing at least 30 movements followed by partial arousal or awakening. (ASDC 1979) </li></ul><ul><li>These limb movements usually occur in deep stage two sleep, but often cause arousal. </li></ul>
  41. Restless Legs Syndrome (RLS) <ul><li>People with RLS complain of an irresistible urge to move their legs while at rest. </li></ul><ul><li>A person with RLS will experience a vague, uncomfortable feeling while at rest that is only relieved by moving the legs. </li></ul><ul><li>Symptoms of RLS may be present all day long, making it difficult for an individual to sit motionless. Or they may be present only in the late evening. Late evening symptoms can lead to sleep onset insomnia, which tends to compound the effects of RLS. </li></ul><ul><li>Pregnancy, uremia, and post-surgery conditions have also been known to increase the incidence of RLS. And, surprisingly, fever seems to decrease it. </li></ul><ul><li>Although one study found RLS to be most prevalent in middle-aged females, its incidence increases with age. </li></ul><ul><li>Restless legs syndrome is estimated to affect 5% of the population. Approximately 80% of people with RLS have PLMD </li></ul>
  42. Sleep disorders related to other conditions <ul><li>In addition to the primary sleep disorders, there are three categories of sleep disorders that are caused by or related to substance use or other physical or mental disorders. </li></ul>
  43. SLEEP DISORDERS RELATED TO MENTAL DISORDERS <ul><li>Many mental disorders, especially depression or one of the anxiety disorders, can cause sleep disturbances. Psychiatric disorders are the most common cause of chronic insomnia. </li></ul>
  44. SLEEP DISORDERS DUE TO MEDICAL CONDITIONS <ul><li>Some patients with chronic neurological conditions like Parkinson's disease or Huntington's disease may develop sleep disorders. Sleep disorders have also been associated with viral encephalitis, brain disease, and hypo- or hyperthyroidism. </li></ul>
  45. SUBSTANCE-INDUCED SLEEP DISORDERS <ul><li>The use of drugs, alcohol, and caffeine frequently produces disturbances in sleep patterns. Alcohol abuse is associated with insomnia. The person may initially feel sleepy after drinking, but wakes up or sleeps fitfully during the second half of the night. Alcohol can also increase the severity of breathing-related sleep disorders. With amphetamines or cocaine, the patient typically suffers from insomnia during drug use and hypersomnia during drug withdrawal. Opioids usually make short-term users sleepy. However, long-term users develop tolerance and may suffer from insomnia. </li></ul><ul><li>In addition to alcohol and drugs that are abused, a variety of prescription medications can affect sleep patterns. These medications include antihistamines, corticosteroids, asthma medicines, and drugs that affect the central nervous system. </li></ul>
  46. Nursing Diagnoses: <ul><li>Sleep pattern disturbances r/t (specific medical condition); use of, withdrawal from, substances, anxiety or depression; circadian rhythm disruption; familial patterns; evidenced by insomnia, hypersomnia, nightmares, sleep terrors, or sleepwalking. </li></ul><ul><li>Risk for injury r/t excessive sleepiness, sleep terrors, or sleepwalking </li></ul>
  47. The following criteria may be used to measure outcomes in the care of the client with sleep disorders: <ul><li>The Client has not: </li></ul><ul><li>Has not experienced injury. </li></ul><ul><li>Verbalizes understanding of the sleep disorder. </li></ul><ul><li>Demonstrates individually appropriate interventions that promote sleep. </li></ul><ul><li>Adjusts lifestyle to accommodate alteration in biological terms. </li></ul><ul><li>Demonstrates improvement in sleep patterns. </li></ul><ul><li>Reports increased sense of well-being and feeling rested. </li></ul>
  48. Treatment Modalities <ul><li>Sleep Disorders </li></ul><ul><li>Primary Insomnia </li></ul><ul><li>Relaxation Therapy </li></ul><ul><li>Biofeedback </li></ul><ul><li>Drug therapy: Sedatives and Hypnotics-Benzodiazepines (Dalmane, Restoril, Halcion); Nonbenzodiazepines (Noctec, Ambien) </li></ul><ul><li>Primary Hypersomnia/Narcolepsy </li></ul><ul><li>Drug Therapy: The usual treatment for hypersomnia is with CNS stimulants such as amphetamines. In some instances, the nonsedating Serotonin-specific reuptake inhibitor antidepressants (flouxetine, sertaline, and paroxetine) may be helpful. </li></ul>
  49. <ul><li>Narcolepsy is also treated with CNS stimulants, such as amphetamine, methylphenidate, or pemoline. </li></ul><ul><li>Tricyclic antidepressants have been effective in the treatment of symptoms of cataplexy. </li></ul><ul><li>Parasomnias </li></ul><ul><li>Treatment usually centers around measures to relieve obvious stress within the family: </li></ul><ul><li>A. Individual or family therapy </li></ul><ul><li>B. Interventions to prevent injury </li></ul><ul><li>C. Use of tricyclic antidepressants or low-dose benzodiazepines. </li></ul>
  50. Sleep Education <ul><li>&quot;Sleep hygiene&quot; or sleep education for sleep disorders often includes instructing the patient in methods to enhance sleep. Patients are advised to: </li></ul><ul><li>wait until he or she is sleepy before going to bed </li></ul><ul><li>avoid using the bedroom for work, reading, or watching television </li></ul><ul><li>get up at the same time every morning no matter how much or how little he or she slept </li></ul><ul><li>avoid smoking and avoid drinking liquids with caffeine </li></ul><ul><li>get some physical exercise early in the day every day </li></ul><ul><li>limit fluid intake after dinner; in particular, avoid alcohol because it frequently causes interrupted sleep </li></ul><ul><li>learn to meditate or practice relaxation techniques </li></ul><ul><li>avoid tossing and turning in bed; instead, he or she should get up and listen to relaxing music or read </li></ul>
  51. <ul><li>End of discussion </li></ul>

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