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sleep disturbance and its patterns


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sleep disturbance and its patterns

  1. 1. SLEEP DISTERBANCES AND ITS PATTERNS PRESENTED BY Mr Abhijit P. Bhoyar 1st year M. Sc Nursing
  2. 2. GENERAL OBJECTIVES =) • At the end of the seminar, student will be able to gain the knowledge regarding sleep disturbances & its patterns & apply this knowledge into providing care to the client.
  3. 3. SPECIFIC OBJECTIVE=) At the end of the seminar student will be able to, Define sleep. Discuss some facts about sleep. Describe the differences in the sleeping patterns. Enlist the factors affecting the sleep. Explain the physiology of sleeping patterns. Define sleep regulation. Discuss about the stages of sleep briefly.
  4. 4. Describe the lack of sleep affect the human body. Explain the short term and long term consciquences of sleep. Explain international classification, sleep disorder and its management. Discuss nursing management of sleep disturbances. Explain role of nurse.
  5. 5. Introduction: When you have insomnia, you're never really asleep, and you're never really awake. (From the movie Fight Club, based on the novel by Chuck Palahniuk)
  6. 6. Definition: SLEEP:- It is a periodic state of rest accompanied by varying degree of unconsciousness and relative inactivity. (Taber’s Cyclopedic Medical Dictionary)
  7. 7. SOME FACTS ABOUT SLEEP YOU PROBABLY DIDN'T KNOW • The record for the longest period without sleep is 18 days, 21 hours, 40 minutes during a rocking chair marathon. The record holder reported hallucinations, paranoia, blurred vision, slurred speech and memory and concentration lapses. • It's impossible to tell if someone is really awake without close medical supervision. People can take cat naps with their eyes open without even being aware of it
  8. 8. • Anything less than five minutes to fall asleep at night means you're sleep deprived. The ideal is between 10 and 15 minutes, meaning you're still tired enough to sleep deeply, but not so exhausted you feel sleepy by day. • A new baby typically results in 400-750 hours lost sleep for parents in the first year • Elephants sleep standing up during non- REM sleep, but lie down for REM sleep
  9. 9. • Ducks at risk of attack by predators are able to balance the need for sleep and survival, keeping one half of the brain awake while the other slips into sleep mode. • British Ministry of Defence researchers have been able to reset soldiers' body clocks so they can go without sleep for up to 36 hrs. Tiny optical fibres embedded in special spectacles project a ring of bright white light (with a spectrum identical to a sunrise) around the edge of soldiers' retinas, fooling them into thinking they have just woken up. The system was first used on US pilots during the bombing of Kosovo
  10. 10. • Seventeen hours of sustained wakefulness leads to a decrease in performance equivalent to a blood alcohol-level of 0.05%. • The 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster and the Chernobyl nuclear accident have all been attributed to human errors in which sleep-deprivation played a role.
  11. 11. • After five nights of partial sleep deprivation, three drinks will have the same effect on your body as six would when you've slept enough • Experts say one of the most alluring sleep distractions is the 24-hour accessibility of the internet.
  12. 12. PHYSIOLOGY OF SLEEP: • Sleep is a cyclical physiological process that alternates with longer periods of wakefulness. The sleep-wake cycle influences and regulates physiological function and behavioral responses. • Circadian rhythms: People experience cyclical rhythms as part of their everyday life. The most familiar rhythm is the 24 hr, day-night cycle known as the diurnal or circadian rhythm (derived from Latin: circa, “about,” and dies, “day”).
  13. 13. • Circadian rhythms influence the pattern of major biological and behavioural functions. • The fluctuation and predictability of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity and mood depend on the maintenance of the 24-hours circadian cycle.
  14. 14. • Circadian rhythms, including daily sleep-wake cycles, are affected by light and temperature and external factors such as social activities and routines work. • All persons have biological clocks that synchronize their sleep cycles. • Some people can fall asleep at 8 pm, whereas other go to bed at midnight or early in the morning. • Different people also function best at different times of the day.
  15. 15. SLEEP REGULATION: • Sleep involves a sequence of physiological states maintained by highly integrated central nervous system (CNS) activity that is associated with changes in the peripheral nervous, endocrine, cardiovascular, respiratory, and muscular systems. • Each sequence can be identified by specific physiological responses and patterns of brain activity.
  16. 16. • Instruments such as the EEG, EMG, and the EOG provide information about some structural physiological aspects of sleep. • Current theory indicates sleep is thought to be an active inhibitory process.
  17. 17. • Therefore, the control and regulation of sleep may depend on the interrelationship between two cerebral mechanism that intermittently activate and suppress the brain’s higher centers to control sleep and wakefulness . • One mechanism causes wakefulness, whereas the other causes sleep.
  18. 18. SLEEP REGULATION (Contd….) • The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. • The RAS receives visual, auditory, pain, and tactile sensory stimuli. Activity from the cerebral cortex (emotions or thought)also stimulates the RAS.
  19. 19. SLEEP REGULATION (Contd….) • Wakefulness results from neurons in the RAS that release catecholamines such as norepinephrine. • Sleep may be produced by the release of serotonin from specialized cells in the raphe sleep system of the pons and medulla. This area of the brain is also called the bulbar synchronizing region (BSR).
  20. 20. • As people try to fall asleep, they close their eyes and assume relaxed position. Stimuli to the RAS decline. • If the room is dark and quiet, activation of the RAS further declines. At some point the BSR takes over, causing sleep.
  21. 21. Disturbance in the cycle • Typical routines cause interruptions in sleep or prevent clients from falling asleep at their usual time. • If a person’s sleep-wake cycle is altered significantly, a poor quality of sleep can result. Reversals in the sleep-wake cycle such as falling asleep during the day (or vice versa for people who work nights) can indicate a serious illness.
  22. 22. • Anxiety, • restlessness, • irritability, and • impaired judgment • The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature, for example, correlate with sleep patterns.
  23. 23. • When the sleep-wake cycle becomes disrupted (e.g by working rotating shifts), other physiological functions may change. • Decreased appetite • Lose weight. • Failure to maintain the individual’s usual sleep-wake cycle can adversely influence the client’s overall health.
  24. 24. STAGES OF SLEEP • Five stages • 1, 2, 3, 4 and REM (rapid eye movement). • These stages progress cyclically from 1 through REM then begin again with stage 1. • A complete sleep cycle takes an average of 90 to 110 minutes.
  25. 25. Stages • Stage 1 – light sleep – can be awakened easily. – the eyes move slowly – muscle activity slows. – many people experience sudden muscle contractions preceded by a sensation of falling.
  26. 26. Stage 2 – eye movement stops – brain waves become slower with only an occasional burst of rapid brain waves. Stage 3: When a person enters stage 3, extremely slow brain waves called delta waves are interspersed with smaller, faster waves.
  27. 27. Stages stage 4: • The brain produces delta waves almost exclusively. • Stages 3 and 4 are referred to as deep sleep, • very difficult to wake • no eye movement or muscle activity. • This is when some children experience bedwetting, sleepwalking or night terrors.
  28. 28. REM Period: • Breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. • Brain waves during this stage increase to levels experienced when a person is awake. • heart rate increases, blood pressure rises, males develop erections and the body loses some of the ability to regulate its temperature.
  29. 29. • This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night.
  30. 30. NORMAL SLEEP REQUIREMENTS & PATTERNS • Sleep duration and quality vary among persons of all age groups Sr. no Age group Sleep pattern 1 Infant 16 hours/day 2 Toddler 12 hours/day 3 Preschooler 11 hours/day 4 Schooler 9 -10hours/day 5 Adolescence 8-9 hours/day 6 adult 6-8 hours/day
  31. 31. FACTORS AFFECTING SLEEP 1. Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain) 2. Drugs and substances (eg. Tryptophan) 3. Lifestyle (eg. Daily routines, exercises) 4. Usual sleep patterns 5. excessive daytime sleepiness
  32. 32. 6) Emotional stress 7) Environment( ventilation) 8) Sound 9) Exercise and fatigue 10)Food and caloric intake) 11)Smoking, alcohol drinkers.
  33. 33. Sleep Deprivation • Sleep deprivation has become one of the most pervasive health problems. • It is estimated that people on average now sleep one and a half hours less than people did a century ago. • lack of sleep can have dramatic effects on quality of life.
  34. 34. How does a lack of sleep affect the body? • A person who loses one night’s sleep will generally be irritable and clumsy during the next day and will either become tired easily or speed up because of adrenalin. • After missing two night’s sleep, a person will have problems concentrating and will begin to make mistakes on normal tasks. • Three missed nights and a person will start to hallucinate and lose grasp of reality.
  35. 35. • In 1997 study found that people whose sleep was restricted to four to five hours per night for one week needed two full nights of sleep to recover performance, alertness and normal mood. • Sleep deprivation reduces emotional intelligence and constructive thinking skills.
  36. 36. Other short-term consequences • Decreased daytime alertness. • Impaired memory and cognitive ability, • Occupational injury. • Impaired immune system.
  37. 37. Long-term consequences • High blood pressure • Heart attack • Heart failure • Stroke • Psychiatric problems such as • Mental impairment • Increased mortality risk • Relationship problems with a bed partner • Obesity
  38. 38. SLEEP DEPRIVATION AND EUPHORIA • Sleep deprivation gives a lot of people a buzz. Especially in the first night of staying up, many people experience euphoria. • sleep deprivation can even be a short-term way to address depression. The effects of depression decline.
  39. 39. • Total sleep deprivation for a whole night improves symptoms in 40-60% of patients . • Sleep restriction is not a viable treatment for depression on an outpatient basis. • Supervision is required.
  40. 40. SLEEP DEPRIVATION IN CHILDREN • Sleep deprivation is particularly a problem for children. • In studies of elementary aged children, nearly 40% had some type of sleep problem, 15% exhibited bedtime resistance and 10% had daytime sleepiness. • Nearly half of teens reported at least occasional difficulty in falling or staying asleep and almost 13% experiencing chronic and severe insomnia.
  41. 41. • This lack of sleep greatly affects mood, behavior, and academic performance. • Insufficient sleep has also been associated with Attention Deficit Hyperactivity Disorder (ADHD), lower social skills and learning difficulties.
  42. 42. THE INTERNATIONAL CLASSIFICAITON OF SLEEP DISORDERS 1. DYSSOMNIAS • A. Intrinsic Sleep Disorders • B. Extrinsic Sleep Disorders • C. Circadian Rythm Sleep Disorders 2. PARASOMNIAS • A. Arousal Disorders • B. Sleep-Wake Transition Disorders • C. Parasomnias usually asscociated with REM Sleep • D. Other Parasomnias 3. MEDICAL/PSYCHIATRIC SLEEP DISORDERS • A. Associated with Mental Disorders • B. Associated with Neurological Disorders • C. Associated with Other Medical Disorders
  43. 43. 4) Proposed Sleep disorders Sr. no. Diseases Categiry 1 Short Sleeper 307.49-0 2 Long Sleeper 307.49-2 3 Sub-wakefulness Syndrome 307.47-1 4 Fragmentary Myoclonus 780.59-7 5 Sleep Hyperhidrosis 780.8 6 Menstrual-Associated Sleep Disorder 780.54-3 7 Pregnancy-Associated Sleep Di7s8o0rd.5e9r-6
  44. 44. Sr. no. Disease categiry 8 Terrifying Hypnagogic Halluc3in0a7t.i4o7n-s4 9 Sleep-Related Neurogenic Tac7h8y0p.n5e3a- 2 10 Sleep-Related Laryngospasm 780.59-4 11 Sleep Choking Syndrome 307.42-1
  45. 45. Types of sleep disorders Sleep disorders are generally put into one of these three categories: • Disturbed sleep • Excessive sleep • Lack of sleep • Lack of sleep, which is most commonly known as insomnia, is the most common type of sleep disorder.
  46. 46. Common Sleep Disorders Insomnia • Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men. • Insomnia includes not only difficulty falling asleep (this is called sleep-onset insomnia) but also waking up to early and not being able to fall back asleep (sleep-maintenance insomnia), frequent awakenings, and waking up feeling un-refreshed.
  47. 47. Symptoms of insomnia • Sleepiness • Fatigue, • Decreased alertness • Poor concentration • Decreased performance • Depression during the day and night • Muscle aches and an overly emotional state.
  48. 48. Types of insomnia • Primary Insomnia • Secondary Insomnia • Chronic insomnia • Rebound Insomnia • Altitude Insomnia • Insomnia related to substance use
  49. 49. Primary Insomnia • Primary insomnia is sleeplessness that cannot be attributed to some other cause. An estimated 10% of the population has primary insomnia. • A patient with primary insomnia must experience difficulty in falling asleep, difficulty in staying asleep, early awakening, or non-restorative, poor quality sleep. • The trouble sleeping must be associated with daytime symptoms. These can include fatigue, trouble concentrating, memory or mood disturbances, tension, headaches.
  50. 50. Secondary Insomnia • Secondary insomnia is a result of other causes-illness, drugs (including caffeine and alcohol), excessive worrying, pain, etc. • Depression is a leading cause of secondary insomnia. • Secondary insomnia causes include stress, arthritis, and drinking too much coffee. The insomnia is a sequela of another problem. • Secondary insomnia is more common than primary insomnia.
  51. 51. Chronic insomnia • insomnia that goes on for a month or more – is often considered chronic insomnia. • Doctors attack insomnia directly (rather than an unknown “underlying cause”) to help the patient achieve a better quality of life.
  52. 52. Rebound Insomnia • Rebound insomnia is when you can’t sleep after coming off sleeping pills. Your brain and body have adjusted to the sleep medication to some extent and almost anticipate it.
  53. 53. Altitude Insomnia • The term “altitude insomnia” is used when people can’t sleep after climbing a mountain. • More properly, there is a condition called Acosta’s syndrome, or hypobaropathy, or altitude sickness, which can have many symptoms, including sleeplessness. • Sensitive individuals experience this when they go up as little as 2000 ft in elevation.
  54. 54. insomnia related to substance use • Substance use refers to alcohol, stimulants, drugs (including sleep aids, both prescription and over the counter.) • Substances are often used in tandem, compounding the effect and making identifying the cause of the sleeplessness difficult.
  55. 55. Treatment Medication – Non-benzodiazepine hypnotics, antidepressants and hypnotics are prescribed. behavioral strategies – Sleep restriction — only sleeping in the bed and only staying in bed when sleeping (falling asleep within 25 minutes of lying down); – Stimulus control — reserving the bedroom for sleep ; – Relaxation techniques; – Avoidance of caffeine and alcohol; – Cognitive behavioral therapy with the help of a psychologist.
  56. 56. Menopause and insomnia • Sleep onset insomnia (trouble getting to sleep) and sleep maintenance insomnia (trouble staying asleep) commonly increase during perimenopause and menopause. • The International Classification of Sleep Disorders includes premenstrual insomnia and premenstrual hypersomnia under the category of menstrual-associated sleep disorder.
  57. 57. Sleep Apnea • The most studied sleep disorder is apnea, a cessation of breathing during sleep. • Sleep apnea is a sleep disorder that causes breathing to repeatedly stop and start. • This can cause discomfort to both the sufferer and a significant other, who may be disturbed by the loud snoring that accompanies sleep apnea.
  58. 58. Types of sleep apnea 1. Central sleep apnea:- Central sleep apnea involves relaxation of the throat muscles 2. Complex sleep apnea (combination of obstructive sleep apnea and central sleep apnea) 3. Obstructive sleep apnea:- Obstructive sleep apnea involves a lack of brain signals that control breathing. Older adults and men are far more likely to suffer from sleep apnea.
  59. 59. Sleep and Depression • Many people do not realize that sleep and depression are linked. • One of the signs of depression is insomnia, also known as lack of sleep or inability to sleep. • Insomnia can also play a role in the development of depression. • Medication, sleep techniques and certain types of therapy can help those who have problems with sleep and depression.
  60. 60. Sleep Inertia • It is a transitional state between sleep and wakefulness. • Sleep inertia refers to the feeling of grogginess most people experience after awakening. • Sleep inertia can last from 1 minute to 4 hours, but typically lasts 15-30 minutes.
  61. 61. • During this period, you are at a reduced level of capacity and may have trouble doing even simple everyday actions. • Awakening during a stage 3 or 4 sleep produces more sleep inertia than awakening in stage 1 or 2.
  62. 62. • Usually people fully “wake up” in a half hour at most. For many, the morning routine of a shower or making coffee helps them through the inertial period. • Drowsy driving – a lot of drowsy driving accidents happen early in the morning, not when the driver has been up too long, but when he or she has recently awoken and is still suffering from sleep inertia. Sleep inertia in a driver behind the wheel can be very dangerous as the impairment of motor and cognitive functions and can affect a person's ability to drive safely.
  63. 63. Snoring
  64. 64. • Snoring is a strong marker for sleep apnea and upper airway resistance. • Simple snoring (without apnea) is sometimes considered to be at the mildest end of the sleep disordered breathing spectrum and is likely to progress.
  65. 65. • Snoring is not benign according to many experts. A study found that snoring was positively associated with the hypertension, cardiovascular disease, and diabetes. • The only intervention strategy accepted at present is weight loss.
  66. 66. Narcolepsy • These “sleep attacks” can last from several seconds to more than 30 minutes and can include cataplexy, hallucinations and temporary paralysis upon awakening. • The disorder is usually hereditary though it can be brought on by brain damage or neurological disease.
  67. 67. • Symptoms usually appear during adolescence. • Stimulants, antidepressants and other drugs can help control the symptoms. • Behavioral measures to control symptoms include strategically timed naps, regular timing of nighttime sleep and avoidance of alcohol and heavy meals.
  68. 68. Restless Legs Syndrome • For about 15% of the population, sleep is made difficult by Restless Legs Syndrome (RLS), an unpleasant crawling, prickling or tickling sensation in the legs and feet and the urge to walk or move them to find relief. • Although not considered serious medically, RLS makes it difficult to fall asleep and stay asleep.
  69. 69. Sleep Bruxism • The word bruxism is derived from the Greek and means gnashing of the teeth. • In simple terms “sleep bruxism” means grinding of teeth during sleep.
  70. 70. NURSING PROCESS • Assessment: Assess client’s usual sleep habits and recent sleep quality If sleep quality is reported to be poor, explore the nature of disturbances by noting the following: • Usual activities in the hour before retrieving • Sleep latency • Number and perceived cause of awakenings • Regularity of sleep pattern • Consistency of rising time
  71. 71. • Frequency and duration of naps • Events associated with initial onset of sleep disturbances • Situations in which client fights sleepiness • Daily caffeine intake • Use of alcohol, sleeping pills, and other medications
  72. 72. • Incidence of morning headaches • Frequency of snoring, apparent pauses in breathing, and kicking movements • Objective data may include visible signs of fatigue and lack of sleep, such as circles under the eyes, lack of coordination, drowsiness and irritability.
  73. 73. Nursing Management Nursing Diagnosis 1.Sleep pattern disturbances related to (specific medical condition); use of , or withdrawal from, substances; anxiety or depression; circadian rhythm disruption; familial patterns; evidenced by insomnia, hypersomnia, nightmares, sleep terrors, or sleepwalking.
  74. 74. Outcome criteria • Client will be able to achieve adequate, uninterrupted sleep • Client will report feeling rested and demonstrate a sensation of wellbeing.
  75. 75. Nursing Interventions • To promote sleep – Encourage activities that prepare one for sleep: soft music, relaxation exercise, warm bath – Discourage strenuous exercise within 1 hr of bedtime – Control intake of caffeine-containing substances within 4 hr of bedtime. – Provide a high-carbohydrate snack before bedtime – Keep the temp of the room between 68°F and 72°F – Instruct the client not to use alcoholic beverages – Discourage smoking and daytime napping
  76. 76. Nursing diagnosis 2 • Risk for injury related excessive sleepiness, sleep tremors, or sleepwalking. Outcome criteria • Client will not experience injury
  77. 77. Nursing interventions • Ensure that siderails are up on the bed. • Keep the bed in a low position • Equip the bed with a bell that is activated when the bed is exited • Keep a night light on and arrange the furniture in the bedroom in a manner that promotes safety. • Administer drug therapy as ordered.
  78. 78. ROLE OF NURSE • Preparing a restful environment • Promoting bedtime rituals • Offering appropriate bedtime snacks and beverages • Promoting relaxation • Promoting comfort
  79. 79. • Respecting normal sleep patterns • Scheduling nursing care to avoid unnecessary disturbances • Using medication to produce sleep • Teaching about rest and sleep
  80. 80. Research Input • Association of physical activity and human sleep disorders. (Archives of Internal Medicine (1998, September 28), 158, 1894-1898) This was the study of 319 men and 403 women who were taking part in the Tucson epidemiologcal study of obstructive airways disease. Part of the study includedcompleting health questionnaires related to physical exercises and sleep disorders. Results: A program of regular exercise may be a useful therapeutic modality for clients with sleep disorders.
  81. 81. SUMMARY • Introduction • Facts about sleep • Definition • Physiology of sleep • Sleep regulation • Stages of sleep • Sleep deprivations • Types of sleep disorders • management
  82. 82. Resources • Taber’s; Cyclopedic Medical Dictionary; copyright in 1997by F. A. Davis Company; published by JAYPEE Brothers; 18th edition; page no.1771. • Essential of medical physiology; K Sembulingam; Prema Sembulingam; 4th edition;published by JAYPEE brothers medical publishers; page no.400, 775,773,834-838. • Fundamental of nursing; standard and practice; 2nd edition; Syc. Delaune; patricia K. Ladner; page no.942- 950. • A concise text book of Advanced Nursing practice; Shebeer. P. Basheer; S. Yaseen Khan; published by EMMESS medical publishers; 1st edition 2012; page no. 273-284.
  83. 83. • Mayo Clinic (2007). Insomnia. Retrieved January 2, 2008, from the Mayo Clinic Web site: • Mayo Clinic (2006). Sleep Apnea. Retrieved January 2, 2008, from the Mayo Clinic Web site: • MedicineNet (2005). Sleep Disorders: Sleep and Depression. Retrieved January 2, 2008, from the MedicineNet Web site: articlekey=47548.
  84. 84. I Can’t ` Sleep Stop thinking about your research protocol submission!!