The document discusses sleep statistics, definitions, sleep cycles, factors affecting sleep, categories and sections of sleep disorders, sleep hygiene, and sleep assessment and management. It provides information on average sleep needs by age, sleep definitions, sleep cycles, factors influencing sleep like physical activity, stress, diet, smoking and environment. It describes categories of sleep disorders like dyssomnias involving too little or too much sleep, parasomnias involving abnormal events during sleep, and sleep disorders related to other conditions. Treatment options for different sleep disorders include lifestyle changes, medications, therapy and managing the underlying condition.

1. Presented By:
Mr. Mahesh Chand
Lecturer
M.Sc. Nursing

2.  Sleep statistics
 Definition
 Sleep Cycle
 Sleep Span
 Factors affecting Sleep
 Categories
 Sections of sleep Disorders
 Sleep Hygiene
 Sleep Assessment
 Management

3.  We spend about 1/3 of our lives asleep.
 Average 3,000 hours of sleep per year.
 Most people do not get enough sleep.
 Effects of sleep deprivation: Problems with
health, mood, concentration, memory,
emotional stability.

4.  Sleep: Sleep is a naturally recurring state of mind
characterized by altered consciousness, relatively
inhibited sensory activity, inhibition of nearly
all voluntary muscles, and reduced interactions with
surroundings.
 It is a naturally occurring altered state of
unconsciousness characterized by decreases in
awareness and responsiveness to stimuli. Sleep is
distinguish from abnormal states of consciousness by
being readily reversible.

6. Age and condition Average amount of sleep per day
New born 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

7.  Physical Activity: Activity and exercise influence
sleep by increasing fatigue. It appears that physical
activity increases both REM and NREM sleep.
 Psychologic Stress: Illness and situation in daily living
that cause psychologic stress tend to disturb sleep.

8.  Motivation: A desire to be wakeful and alert helps
overcome sleepiness and sleep. E.g. A tired person may
be wakeful and alert when at a party or when attending
an interesting play.
 Alcohol Intake: Large quantity have been found to
limit REM and delta sleep.
 Caffeine Containing Beverages: Caffeine is a central
nervous stimulant. Eg. coffee, tea, chocolate.

9.  Diet: It has long been believed that the dietary amino
acid L-tryptophan acts to promote sleep. A small
protein snack before bed time was frequently
recommended to clients with insomnia. Protein may
actually increase brain energy alertness and
concentration, while carbohydrate appear to have an
effect on brain serotonin levels and promote feeling of
calmness and relaxation.

10.  Smoking: Nicotine has a stimulating effect and
smokers usually have a more difficult time falling
asleep. Clients who stops smoking have an increase in
periods of day time sleepiness and report restlessness at
night.
 Environment factor: Lifestyle affect the ability to sleep
well. E.g. Duty rotation

11.  Illness: Illness acts as a physiologic and psychologic
stressors as a result influences sleep. Certain illnesses
are more closely related to sleep disturbances E.g.
Gastric secretions increases during REM sleep.
 Medications: Sleep quality is also influenced by
certain drugs. The drugs which decrease REM sleep are
barbiturates, amphetamines and antidepressants. Short
acting benzodiazepine are used to maintain sleep.

12.  Dyssomnias
 Parasomnias
*This classification system is similar to that
used by the American Sleep Disorders
Association.

13.  The sleep itself is pretty normal.
 But the client sleeps too little, too much, or at
the wrong time.
 So, the problem is with the amount (quantity),
or with its timing, and sometimes with the
quality of sleep.

14.  Something abnormal occurs during sleep itself,
or during the times when the client is falling
asleep or waking up (e.g., bad dreams.)
 The quality, quantity, and timing of the sleep
are essentially normal.

15. I. Primary Sleep Disorders include all
sleep disorders, except:
II. Sleep Disorder Related to Another Mental
Disorder
III. Sleep Disorder Due to a General
Medical Condition (GMC)
IV. Substance-Induced Sleep Disorder

16.  Dyssomnias
A. Primary Insomnia - too little sleep
Insomnia is a sleep disorder. People with insomnia
have trouble sleeping: difficulty falling asleep, or
staying asleep as long as desired.
Insomnia can occur at any age, but it is particularly common in
the elderly. Insomnia can be short term (up to three weeks) or
long term (above 3–4 weeks).

17.  Transient insomnia :lasts for less than a week. It can be
caused by changes in the sleep environment, by the timing
of sleep, severe depression, or by stress.
 Acute insomnia: inability to consistently sleep well for
a period of less than a month.
 Chronic insomnia: lasts for longer than a month. It can
be caused by another disorder, or it can be a primary
disorder. They might include muscular weariness,
hallucinations, and/or mental fatigue.

18.  Use of psychoactive drugs, medications, herbs,
caffeine, nicotine.
 Mental disorders such as bipolar disorder, clinical
depression, generalized anxiety disorder
 Previous thoracic surgery
 Poor sleep hygiene e.g., noise

19.  difficulty falling asleep, including difficulty
finding a comfortable sleeping position.
 waking during the night and being unable to
return to sleep.
 feeling unrefreshed upon waking
 daytime sleepiness, irritability or anxiety

20.  Non-pharmacological:
Music may improve insomnia in adults.
Sleep hygiene is a common term for all of the behaviors
which relate to the promotion of good sleep.
 Medication:
oAntihistamines eg. diphenhydramine or doxylamine
oAntidepressants eg. amitriptyline, doxepin
oBenzodiazepines eg. Normison
o Antipsychotics

21. B. Primary Hypersomnia :
It is characterized by recurrent episodes of
excessive daytime sleepiness or prolonged night time sleep.
◦ Characteristics
 Excessive sleepiness
 Persists for 1 month or longer
 Rarely a diagnosis independent of an Axis I or II disorder or
a GMC or substance use.

22.  anxiety
 increased irritation
 decreased energy
 restlessness
 slow thinking
 slow speech
 loss of appetite
 hallucinations
 memory difficulty

23.  The ideal treatment for hypersomnia is based upon the
symptoms experienced. Stimulant medications, such as
dose-controlled amphetamines, most-often prescribed
for ADHD.eg. amphetamine, methylphenidate.
 Other drugs used to treat hypersomnia include
clonidine, levodopa, bromocriptine,
activating antidepressants, and monoamine oxidase
inhibitors.
 Behavioral techniques can also be helpful for
regulating one’s sleep

24.  It is a chronic neurological disorder involving the loss
of the brain's ability to regulate sleep-wake cycles
 Symptoms include excessive daytime sleepiness, sleep
paralysis, hypnologic hallucination.

25.  People with narcolepsy can be substantially helped, but
not cured.
 Main treatment of excessive daytime sleepiness in
narcolepsy is central nervous system stimulants such
as methylphenidate, amphetamine, dextroamphetamine,
modafinil, and armodafinil.
 Other medications are used such
as atomoxetine, codeine and selegiline.
 Another FDA-approved treatment for narcolepsy
is sodium oxybate.

26. D. Breathing-Related Sleep Disorder;
Characteristics
 Sleep disruption (excessive sleepiness or insomnia)
◦ Due to sleep-related breathing condition (e.g.,
Obstructive Sleep Apnea Syndrome)

27. Treatment:-
 In mild cases: weight loss, sleeping on one’s
side, and avoiding hypnotics and alcohol
(To sleep on side, a tennis ball can be sewn into
back of client’s sleep wear).
 In more serious cases: a machine that provides
continuous positive airway pressure.
 Surgery: Few benefits

28. E. Circadian Rhythm Sleep Disorder :
Characteristics:-
◦ Persistent or recurrent pattern of sleep
disruption leading to excessive sleepiness or
insomnia, due to mismatch between sleep-
wake schedule required by a person’s
environment and his/her circadian sleep-
wake pattern (e.g., shift work).

29. Treatment:
Difficult to treat, because it has to involve the entire
family
 Darken bedroom and use sound proofing.
 Limit caffeine and hard to digest food.
 Ensure all family members learns shift.
 To help jet lag, exposure to sun helps.

30. A. Nightmare Disorder:
Nightmare disorder, also known as 'dream anxiety
disorder', is a sleep disorder characterized by
frequent nightmares.
Characteristics:
(1) Repeated awakenings from bad dreams.
(2) When awakened client becomes
oriented and alert

31. Information about Nightmare Disorder
◦ Usually occurs in early morning when REM sleep
dominates.
◦ The same nightmare may recur repeatedly or
different ones may pop up three times a week.
◦ Stress may induce 60% of nightmares.
◦ Half of the cases of nightmare disorder appear before
age 10; 2/3 before age 20.
◦ Dreams are clearly remembered
◦ Drugs can trigger nightmares.
◦ Suddenly withdrawing REM-suppressant
medications and drugs can cause REM rebound.

32. Treatment:
 Yoga and meditation can also help to
eliminate stress and create a more peaceful
sleeping atmosphere.
 Medications like prazosin are sometimes used
to treat nightmares

33. B. Sleep Terror Disorder:
Night terror, also known as sleep terror, is
a sleep disorder, causing feelings of terror or dread, and
typically occurs during the first hours of stage 3-4 non-
rapid eye movement sleep.
Usually only children have sleep terror disorder.
The client is not having a nightmare.
The eyes are open, screams erupt.
Usually happens in early evening.

34. In contrast to nightmares, sleep terrors do not respond to
psychotherapy.
Probably due to brain wave upset, fever, or medications
However, some medications may help.
Treatment:
 Psychotherapy or counseling can be helpful in many cases.
 Benzodiazepines (diazepam) or tricyclic antidepressants may
used; however, medication is only recommended in extreme
cases

35. C. Sleepwalking Disorder:
Sleepwalking, also known
as somnambulism or noctambulism, is a sleep
disorder belonging to the parasomnia family.
Sleepwalkers arise from the slow wave sleep stage in a state
of low consciousness and perform activities that are usually
performed during a state of full consciousness.
These activities can be as benign as sitting up in bed,
walking to a bathroom, and cleaning, or as hazardous as
cooking, driving.
Most sleepwalking children are psychologically normal.
Begins between ages 6 and 12 and may be stress-related.

36. Characteristics:
1. Rising from bed during sleep and walking about.
2. Usually occurs early in the night.
3. On awakening, the person has amnesia for episode.
4. At some time 1-6% of children sleepwalk; of these, 15% do
so occasionally.
5. Adult sleepwalking is far less common, usually worse and
more chronic.

37. Treatment:
 Relaxation techniques.
 Biofeedback training.
 May need to sleep on the ground floor, have outside doors
securely locked, and have car keys unavailable.
 Good sleep hygiene and avoiding sleep deprivation is also
recommended.
 Drugs can be prescribed for sleepwalkers, such as a low dose
of benzodiazepines, such as clonazepam, and tricyclic
antidepressants.

38. I. Primary Sleep Disorders include all
sleep disorders, except:
II. Sleep Disorder Related to Another Mental Disorder
III. Sleep Disorder Due to a General
Medical Condition (GMC)
IV. Substance-Induced Sleep Disorder

39.  Two Diagnoses
1. Insomnia Related to Another Mental
Disorder.
2. Hypersomnia Related to Another
Mental Disorder

40. 1. Insomnia Related to Another Mental
Disorder
Characteristics
 Difficulty in initiating or maintaining sleep
 Persists for at least 1 month
2. Hypersomnia Related to Another
Mental Disorder
Characteristics:
 Excessive sleepiness
 Persists for at least 1 month

41. Prominent disturbance in sleep that is sufficiently
severe to warrant independent clinical attention.
 Evidence has to be present that the sleep disturbance
is a direct physiological consequence of a general
medical condition.
 Specify Type:
(1) .52 Insomnia Type
(2) .54 Hypersomnia Type
(3) .59 Parasomnia Type
(4) .59 Mixed Type

42. Characteristics
◦ Evidence must be present that the sleep disturbance is a
direct physiological consequence of substance use.
◦ Substance use that produces a sleep disorder severe enough
to warrant independent clinical attention
Code:
291.8 Alcohol; 292.89 Amphetamine; 292.89 Caffeine; 292.89
Cocaine; 292.89 Opioid; 292.89 Sedative, Hypnotic, or
Anxiolytic; 292.89 Other (or unknown) Substance

43. Types:
Insomnia Type
Hypersomnia Type
Parasomnia Type
Mixed Type

44.  Establish a set bedtime routine.
 Set a regular sleep and wake time.
 Go to bed when tired & get out of bed if unable to sleep
within 15 minutes.
 Reduce noise, light, stimulation, & temperature in
bedroom.
 Restrict activities in bed to those that help induce sleep.
 Avoid using caffeine & nicotine 6 hours before bedtime.

45.  Limit use of alcohol or tobacco.
 Do not exercise or participate in vigorous activities in
the evening.
 Exercise during the day.
 Eat a balanced diet.
 Increase exposure to natural and bright light during
the day.
 Educate self about normal sleep and sleep behavior.

46. 1. Questionnaires:
Several questionnaires have been developed to help to
identify sleep patterns. They are either designed to
obtain specific information or are unstructured to give
the person more freedom to respond. Examples are—
• When you think about your sleep, what kinds of impressions
come to mind?
• Do you fall asleep at inappropriate times?
• How long does it takes for you to fall asleep?
• Do you fall asleep during physical activities?
• Have you been told that you stop breathing while asleep?

47. 2. Sleep Diary: A sleep diary is a daily account of
sleeping and walking activities. The client or personnel
compile the information in a sleep disorder clinic. The
client notes the time he or she sleep, describes daily
activities, 24 hour log of consumed food and beverages
and notes when he or she takes medications. These self
kept diaries generally cover a 2 week period.

48.  Brain waves
 Nasal and oral airflow
 eye movements
 Snoring sound
 Muscle tone
 Oxygen level in blood
 Body position
 limb movement
 Chest and abdominal
respiratory effort

49. 4. Multiple Sleep Latency Test: A MSLT is
another helpful study. The person undergoing this test
is asked to take to a daytime nap at 2hours intervals
while attached to sensors similar to those used in
polysomnography. The client is allowed to nap for
about 20 minutes. The nap periods are repeated four to
five times throughout the day. Client who have certain
sleep disorders causing day time sleepiness have a
short latency period- that is they fall asleep in less than
5 minutes. Most well rested persons take an average of
15 minutes before they experience the onset of daytime
sleep.

50. Preparing a restful environment.
Promoting bed time rituals.
Offering appropriate bedtime snacks and beverages.
Promoting comfort.
Respecting normal sleep wake patterns.
Scheduling nursing care to avoid unnecessary
disturbance.
Use medication to produce sleep.
Teaching about rest and sleep.

51.  A concise textbook of Advance Nursing
Practice
 Bashir Jaypee Publications
 Page No. 259- 273
https://en.wikipedia.org/wiki/Sleepwalking
https://en.wikipedia.org/wiki/Sleepterror
https://en.wikipedia.org/wiki/Sleepwalking
https://en.wikipedia.org/wiki/Nightmare
https://en.wikipedia.org/wiki/Primaryinsomnia