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1. AMBO UNIVERSITY
WOLISO CAMPUS
DEPARTMENT:- NURSING
GROUP 1
ASSIGNMENT OF PSYCHIATRY

2. NORMAL SLEEP

3. objective
• Definiton of sleep
• Physiology of sleep
• Stages of sleep
• Sleep cycles
• Sleep pattern
• Dreams
• Functions of sleep
• Average Sleep Requirements
• Factors Affecting sleep

4. Sleep
• Sleep refers to a state of altered consciousness
during which an individual experiences minimal
physical activity and a general slowing of the
body’s physiological processes
• Sleep generally occurs in a periodic cycle and
usually lasts for several hours at a time.
• As a restorative function, sleep is necessary for
physiological and psychological healing to occur.

5. PHYSIOLOGY OF SLEEP
Controlled by recticular-activating system:-
• Are located in the upper brain stem contains
special cells that maintain.
– alertness,
–wakefulness,
– rapid eye mov’t &
– concentration; by releasing catecholamine’s
such as NE from neurons.

6. Cont…
• The RAS receives visual, auditory, pain, &
tactile sensory stimuli
• The specialized cells in the sleep system
release serotonin w/c produces sleep.
• Sleep is a cyclical physiological process
– Circadian rhythm
– Biological clocks

7. Cont…
• The hypothalamus has control centres for
several involuntary activities of the body, one
of which concerns sleeping and waking.
• Injury to the hypothalamus may cause a
person to sleep for abnormally long periods.

8. Stages of Sleep
(i) Electro-encephalogram (Head)
(ii) Electro-oculogram (Eye)
(iii) Electro-myogram (Neck) are used to
identify stages of sleep.
– The stages of sleep are classified in two
categories:
• Non-rapid eye movement (NREM) and
• Rapid eye movement (REM) sleep.

9. A) Non-rapid eye movement (NREM)
• it is not associated with rapid eye movements
• Sleeper progresses through 4 stages for
typical 90-minute sleep cycle,
• It accounts 75-80% of sleep time.
• Less vivid dreaming occurs.

10. NREM sleep consists of four different stages
Stage-1 NREM
– Lightest level of sleep
– Eyes tend to roll slowly side to side
– Lasts a few minutes,10 min
– Decreased physiological activities, gradual
fall in V/s.
– Sensory stimuli such as a noise easily arouses
person.
– If a person awakened, day dreaming may
occur.

11. Stage-2 NREM
–Period of sound sleep, but still fairly light
sleep
–Loss of slow rolling eye movements
–Relaxation progress
–Arousal is relatively easy
–Lasts from 10 to 20 Minutes
–Body functions continue to slow

12. Stage -3 NREM
– Initial stages of deep sleep
– Sleeper is difficult to arouse and rarely
moves.
–Muscles are completely relaxed
– V/s decline but remains in normal range
– Lasts 15-30 minutes.

13. Stage 4-NREM
– Deepest stage of sleep
– Very difficult to arouse sleeper
– V/s is significantly lower than during waking
hours.
– Lasts 15- 30 minutes.
– Sleep walking & enuresis ( bed-wetting
)sometime occur.

14. N.B- The amount of time spent in each stage
varies over the life span.
– new born & a child spend more time in deep
sleep,
– Aging persons spends more time in lighter
stages.
• Shifts to light sleep or wakefulness occurs
suddenly, whereas shifts to deep sleep tend to
be gradual.

15. B) REM- sleep
– because in this type of sleep the person makes
rapid movements by his eyes , in spite of the fact
that he is sleeping
– Full color dreaming occurs- ( Vivid dreams)
– Rapid eye movements
– Stages usually begin 90 minutes after sleep has
begun
– Typified by autonomic response of REM,
Fluctuating HR & RR.
– Increased or fluctuating BP.

16. Loss of skeletal muscle tone
– Gastric secretions increase
– Very difficult to arouse sleeper
– Duration of REM sleep increases with each
cycle & averages 20 minutes.

17. Sleep cycles
• Sleep cycle refers to the sequence sleep that
begins with four stages NREM sleep in order,
with a return to stage 3, then 2 and then
passage into the 1st REM stage.

18. Sleep cycles

20. Sleep pattern
• Difference between NREM & REM sleep
• Begins with deepening NREM sleep
• Interrupted about every 90 min by REM
• Sleep 4-6 NREM-REM cycles/night
• More REM towards morning

21. Dreams
• Dreams: - occur as the brain filter stored
information
about the day’s activities during a sleep.
– occur during both phases
– dreams of REM sleep are more vivid & elaborate.
– Dreams are influenced by personality
e.g. A creative has elaborate & complex dreams,
while a depressed person dreams of helplessness.

22. Functions of sleep
• It restores physiological & psychological
function
 Rest full sleep preserves
• cardiac function
• Respiration
• BP & Muscle tone

23. Cont…
• Protein synthesis & cell division
• conserves energy
• REM sleep is important for cognitive
restoration, brain tissue restoration.

24. Average Sleep Requirements
average sleep duration at different ages

25. Factors Affecting sleep
1. Drug & substances:
• Medications alter sleep & weaken day time
alertness.
• Hypnotics
• Antidepressants & stimulants
• Alcohol
• Diuretics e.g Furosemide
• Caffeine

26. Cont…
2 .Lifestyle: An individual working a rotating
shift
3. Usual sleep pattern
4. Emotional stress: worry , loss of loved one
etc
5. Environment: - ventilation, Noise in
sleeping place, light levels.
-The size, firmness & position of bed.

27. Cont…
6. Exercise & fatigue:- excess fatigue resulting
from exhausting or stressful exercise/work
makes falling asleep difficult.
7. Food & caloric intake: - eating a large, heavy
& spicy meal at night
- Coffee, tea, cola, chocolate contain caffeine
xanthenes that cause sleeplessness

28. Cont…
8. Physical illness
• Respiratory disease causes SOB=OSA.
• hypertension causes early morning
awakening & fatigue,
• hypothyroidism ↓ses stage 4 sleep,
• hyperthyroidism causes persons to take
more time to fall asleep

29. SUMMARY
• Sleep Deprivation can decrease cognitive
performance
• Sleep has got functional significance for Brain
Restitution, Learning, and Memory
• Sleep disturbances occur in virtually all
psychiatric illnesses
• Principles of sleep hygiene include improvement
of sleep environment, Encouraging bedtime
routine and avoiding sleep disturbing
substances/activities after evening hours

30. REFERENCES
• Benjamin James Sadock, Virginia Alcott
Sadock, Pedro Ruiz. Comprehensive Textbook
of Psychiatry. 9 th ed. Philadelphia: Lippncott
Williams & Wilkins.
• Benjamin James Sadock, Virginia Alcott
Sadock. Synopsis of Psychiatry. 10th ed.
Philadelphia: Lippncott Williams & Wilkin