3. INTRODUCTION
Nearly one third of our life is spent in sleep. Every
day we voluntarily go to bed and transit into an easily
reversible state of relative unresponsive and
tranquility. This state occurs almost regularly and
repetitively each day. Sleep has long been assumed
to have restorative function and recently many
people believed sleep to be a passive state of
decreased stimulation.
4. DEFINITION
Sleep can be defined as state of consciousness
characterized by decreases in awareness and
responsiveness to stimuli. Sleep is distinguished
from consciousness by being readily reversible.
5. INCIDENCE
Almost a third of the general population has some
problems with sleep during any given year. More
than half of the 9000 participants in a study of sleep
in elderly persons (65 years or older) reported the
following as sleep pattern disturbance that they
experience most of the time:
8. STAGES OF SLEEP
POLYSOMNIGRAPHIC PROFILES TWO STATES OF SLEEP
RAPID EYE MOVEMENT SLEEP OR D- SLEEP
(DESYNCHRONIZED SLEEP OR DREAMING SLEEP OR
ACTIVE SLEEP
NON-RAPID EYE MOVEMENT SLEEP (NREM), OR S-
SLEEP (SYNCHRONIZED SLEEP) PR QUITE SLEEP OR
ORTHODOX SLEEP.
10. STAGE I
includes lightest level of sleep
stage lasts a few minutes
decreased physiological activity begins with gradual fall in
vital signs and metabolism
sensory stimuli such as noise, easily arouse sleeper
if awakened, person feels as though daydreaming has
occurred
11. STAGE II
includes period of sound sleep
relaxation progresses
arousal is still relatively easy
stage lasts 10 – 20 mts
body functions continue to slow
the brain waves are frequently mixed and low voltage in
pattern, with bursts of activity called sleep spindles and large
amplitude waves called K complexes
12. STAGE III
it involves initial stages of deep sleep
sleeper is difficult to arouse and rarely moves
oxygen consumption
muscles are completely relaxed
vital signs decline, but remain regular
stage lasts 15 – 30 mts
13. STAGE IV
it is deepest stage of sleep
it is very difficult to arouse sleeper
If sleep loss has occurred, sleeper will spend considerable
portion of night in this stage.
Vital signs are significantly lower than during waking hours
Stage lasts approximately 15 – 30 mts
Sleep walking and enuresis sometimes occur
Stage 3 and 4 known as slow wave sleep, named for the
characteristic high voltage and low – frequency delta waves
15. FUNCTION OF SLEEP
It is a time of restoration and preparation for the next
period of wakefulness
During NREM stage 4 body releases human growth
hormone for the repair and renewal of epithelial and
specialized cells such as brain cells
Protein synthesis and cell division for the renewal of
tissues occur during rest and sleep
REM sleep appears to be important for cognitive
restoration
17. FACTOERS AFFECTING SLEEP
A number of factors affect the quality and quantity of sleep. Often more
than one factor combined to cause a sleep problem.
Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain)
Drugs and substances (eg. Tryptophan)
Lifestyle (eg. Daily routines, exercises)
Usual sleep patterns and excessive daytime sleepiness
Emotional stress
Environment ( ventilation)
19. ICD 10 SLEEP DISORDER
CLASSIFICATION
G47 Sleep disorders
G47.0 Insomnia
G47.00 …… unspecified
G47.01 …… due to medical condition
G47.09 Other insomnia
G47.1 Hypersomnia
G47.10 …… unspecified
20. G47.10 …… unspecified
G47.11 Idiopathic hypersomnia with long sleep time
G47.12 Idiopathic hypersomnia without long sleep time
G47.13 Recurrent hypersomnia
G47.14 …… due to medical condition
G47.19 Other hypersomnia
G47.2 Circadian rhythm sleep disorders
G47.20 Circadian rhythm sleep disorder, unspecified type
21. G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
G47.24 Circadian rhythm sleep disorder, free running type
G47.25 Circadian rhythm sleep disorder, jet lag type
G47.26 Circadian rhythm sleep disorder, shift work type
G47.27 Circadian rhythm sleep disorder in conditions
classified
23. G47.35 Congenital central alveolar hypoventilation syndrome
G47.36 Sleep related hypoventilation in conditions classified elsewhere
G47.37 Central sleep apnea in conditions classified elsewhere
G47.39 Other sleep apnea
G47.4 Narcolepsy and cataplexy
G47.41 Narcolepsy
G47.411 …… with cataplexy
24. G47.419 …… without cataplexy
G47.42 Narcolepsy in conditions classified elsewhere
G47.421 …… with cataplexy
G47.429 …… without cataplexy
G47.5 Parasomnia
G47.50 …… unspecified
G47.51 Confusional arousals
G47.52 REM sleep behavior disorder
G47.53 Recurrent isolated sleep paralysis
25. G47.54 …… in conditions classified elsewhere
G47.59 Other parasomnia
G47.6 Sleep related movement disorders
G47.61 Periodic limb movement disorder
G47.62 Sleep related leg cramps
G47.63 Sleep related bruxism
G47.69 Other sleep related movement disorders
G47.8 Other sleep disorders
G47.9 Sleep disorder, unspecified
26. SLEEP DISORDER
Sleep pattern disturbance is a nursing diagnosis that
is defined as a disruption of sleep time that causes
discomfort or interferes with a desired life cycle. A
sleep pattern disturbance may be related to one of
more than 80 sleep disorders identified in the
international classification of sleep disorders, a partial
list of which is given below:
27. The Dyssomnias include sleep disorders characterized
by difficulty in initiating or maintaining sleep (insomnia)
or by excessive sleepiness. These disorders may arise
predominantly from within the body (intrinsic), from
external sources (extrinsic), or from disruption of
circadian rhythm.
INTRINSIC SLEEP DISORDER
EXTRINSIC SLEEP DISORDER
1. DYSSOMNIAS
28. INTRINSIC SLEEP DISORDER
1. INSOMNIA
2. NACRCOLEPSY
3. SLEEP APNEA SYNDROME
a) OBSTRUCTIVE SLEEP APNEA
b) CENTRAL SLEEP APNEA SYNDROME
4. PERIODIC LIMB MOVEMENT DISORDER
5. RESTLESS LEG SYNDROME
29. EXTRINSIC SLEEP DISORDER
1.CIRCADIAN RHYTHM SLEEP DISORDER
2.PARASOMNIAS
a.AROUSAL DISORDER
b.SLEEP-WAKE TRANSITION DISORDERS
c. PARASOMNIAS USUALLY ASSOCIATED WITH REM
SLEEP
d.OTHER PARASOMNIAS
30. 3.SLEEP DISORDES ASSOCIATED WITH
MEDICAL OR PSYCHIATRIC DISORDERS
A. NEUROTRANSMITTER IMBALANCES
B. HEAD INJURY
C.HORMONAL IMBALANCES
D.RESPIRATORY DISORDERS
E. CARDIOVASCULAR DISORDERS
F. GASTROINTESTINAL DISORDERS
G.OTHER DISORDERS
31. G.OTHER DISORDERS
Numerous Other disorders such as, skin conditions (atopic
eczema), fibromyalgia, and seizures seem to have an effect on
or an association with sleep.
34. MSLT is performed to assess the impairment of
daytime alertness. It is performed a day after a
standard polysomnogram. The time required for
clients to fall asleep when in a relaxed state is
evaluated at 2 hour intervals, with each nap limited
to 20 minutes. The type of sleep also is assessed.
35. SLEEP MEASUREMENT
Electroencephalogram (EEG) measures the electrical
changes in the brain. The electrodes are placed on the scalp.
The wavy lines recorded by the EEG are called brain waves.
Electrooculogram (EOG) measures the electrical changes
as the eyes rotate in its socket. The electrodes are placed
either above and below the eye or left and right of the eye.
36. Electromyogram (EMG) measures the electrical
changes generated during muscle contraction. The
electrodes are placed under the chin.
EEG, EOG and EMG are recorded simultaneously
and the patterns of activity in these three systems
provide basic classification for the different types of
sleep.
37. SLEEP MEASUREMENT TOOL
National Sleep Foundation’s Sleep Diary
The National Sleep Foundation’s Sleep Diary is easy to use
and takes just a few minutes each day to complete. It asks
about things that can help, or hinder, a good night’s sleep,
including the person’s bedroom environment, sleep habits,
and caffeine consumption. Completing the Sleep Diary every
morning and evening for a week or more captures valuable
information that assists individuals and their health care
providers to identify patterns and practices that foster.