Sleep is a normal state of altered consciousness that allows the body to rest. It involves decreased responsiveness and can be characterized by different sleep stages including slow-wave non-REM sleep and REM sleep. Sleep requirements vary by age but most adults need 6-8 hours per night. Disorders can cause difficulties initiating or maintaining sleep (insomnia) or excessive daytime sleepiness (hypersomnia). Treatment depends on the underlying cause but may involve changes to sleep hygiene, medications, or addressing lifestyle factors. Nursing care focuses on establishing regular sleep schedules and routines to support restful sleep.

1. Sleep disorders

2. What is sleep?
Sleep can be defined as a normal state of
altered consciousness during which the body
rests;
It is characterized by decreased responsiveness
to the environment, and a person can be
aroused from it by external stimuli.

3. NORMAL SLEEP REQUIREMENTS & PATTERNS
Sleep duration and quality vary among
persons of all age groups
• Infants - 16 Hours /Day
• Toddlers - 12 Hours /Day
• Preschoolers - 11 Hours /Day
• Schoolers - 9 - 10 hours /day
• Adolescents - 8 – 9 hours /day
• Adults - 6 – 8 hours /day

4. Phases of sleep
1.Slow-wave sleep (NonREM):
Phase 1-4
2. Paradoxical/desynchronized sleep (REM-
Rapid Eye Movements)

5. Slow-Wave (nonREM) Sleep
• Entrance to sleep
• Takes appr. 90 minutes with 5-20 minutes
intervals
• Peripheral vessel tone and body functions decrease
• Muscle tone decreases
• 10-30% decrease in blood pressure, respiration
rate and basal metabolism
• Spinal reflexes can be elicited but stretch (deep
tendon) reflexes are absent.

6. Slow-Wave (nonREM) Sleep
• Dreams cannot be remembered
• Theta and delta waves in EEG
• Duration and frequency decrease with age
• Has 4 different stages

7. Phase-1 nonREM
• Transition period between wakefulness and
sleep;
• takes approximately 1-15 minutes.
– Eyes closed and relaxed...
– Light sleep, hallucination-like visions...
α (alpha) waves weaken, slower θ (delta)
waves emerge.

8. Phase-2 nonREM
• First stage of the real sleep; takes about 20 minutes...
• Sleep spindles: 12-14 Hz sharp waves appear for 1-2
seconds.
• Slow eye movements.
• Hard to awaken.
• Fragments of dreams may present

9. Phase-3 nonREM
• Half-way deep sleep
• Body temperature and blood pressure decreases
• Harder to awaken
• Low frequency δ (theta) waves
• Sleep spindles are decreased
• No slow eye movements

10. Phase-4 nonREM
• Deepest sleep; takes about 30-40 mins.
• δ (theta) waves predominate
• Most reflexes are intact; muscle tone slightly
decreased
• Sleep-walking; sleep-talking; snoring and
bedwetting generally occurs in this stage.

11. Sleep Stages-EEG

12. REM Sleep
• 5-30 minutes with 90 minute-intervals
• Active dreaming (dreams are remembered)
• Active body movements
• More difficult to wake up with sensory stimulations
• Waking up in the morning generally coincides with the
last REM period.
• Decrease in muscle tone (except respiratory and eye
muscles)
• Irregularity in heart and respiration rate.
• 20% increase in brain metabolism

13. REM Sleep
• Atonia in neck muscles
• Rapid eye movements
• Beta waves in EEG
=paradoxical sleep, =desynchronized sleep

15. Physiological effects of sleep
Sleep,
• Helps the maintenance of normal activity level of CNS.
• Helps to maintain the “balance” between the different
parts of the CNS.
• Increased sympathetic activity and muscle tone
during the awake period decreases with sleep.
• Body temperature drops, energy loss decreases
• Growth hormone and cortisol secretion increases
• Phosphate excretion from kidneys increase
• Melatonin secretion increases
• Skin and tissue repair occurs

16. FACTORS AFFECTING SLEEP
• Physical illness (eg. Nausea, mood disorders, breathing
difficulty, pain)
• Drugs and substances
• Lifestyle (eg. Daily routines, exercises)
• Usual sleep patterns and excessive daytime sleepiness
• Emotional stress
• Environment ( ventilation)
• Sound
• Exercise and fatigue
• Food and caloric intake

17. Sleep disorders
1. Dyssomnias
 Insomnia
 Hypersomnia
 Disorders of sleep –wake schedule
2. Parasomnias
 Stage IV disorders
 Other disorders

18. Insomnia
• Insomnia refers to disorder of initiation and
maintenance of sleep.
• This includes frequent awakening during the
night and early morning awakening.

19. Causes of Insomnia
Medical illness:
• Any painful illness
• Heart disease
• Respiratory disease
• Brainstem lesions
• Delirium
• Musculo-skeletal disease
• Old age

20. Alcohol and drug use:
• Chronic alcoholism
• Delirium tremens
• Amphetamines or other stimulants
Psychiatric disorders:
• Mania
• Major depression
• Dysthymia
• Schizophrenia and other psychosis
• Anxiety disorders

21. Social causes:
• Financial loss
• Separation or divorce
• Death of a close relative or spouse
• Retirement
• Stressful life situations
Behavioural causes:
• Naps during the day
• Irregular sleeping hours
• Lack of physical exercise
• Excessive intake of beverages like coffee.
• Disturbing environment

22. Treatment
• A through medical and psychiatric assessment to identify
the cause.
• Polysomnography: ( also called a sleep study, is a test
used to diagnose sleep disorders.
Polysomnography records brain waves, the oxygen
level in blood, heart rate and breathing, as well as eye and
leg movements during the study)
• Treat underlying cause
• Withdrawal of current medications if any
• Transient insomnia can be treated initially with
hypnosis.

23. Non pharmacologic treatment for insomnia
• Progressive muscle relaxation
• Autosuggestion
• Meditation, yoga
• Stimulus control therapy:
- Do not use the bed for reading and chatting.
- Go to bed only for sleep.

24. Autosuggestion
Autosuggestion are positive words and sentences use
repeatedly to change ones own perception. It is an effective
method for ending bad habits.
Techniques:
• As you lie on your back in bed, rest your hands gently on
your chest. Choose a positive suggestion to give yourself --
something short and direct.
• Example: "Tonight I will sleep deeply and peacefully... and
I'll wake up tomorrow morning feeling great."
• Repeat the suggestion 10 times slowly in your mind -- or
out loud, if doing so won't disturb a bedmate.
• Each time you repeat the suggestion, gently press your
fingers into your chest. This helps "anchor" the suggestion
in your body. Keep your eyes closed at all times.

25. Sleep hygiene
• Regular, daily physical exercise in the evening.
• Avoid fluid intake and heavy meals before bedtime.
• Avoid caffeine intake before sleeping hours.
• Avoid reading or watching television while in bed.
• Take warm milk before bedtime.
• Sleep in comfortable position.

26. Hypersomnia
• Hypersomnia is a disorder of
excessive somnolence (DOES).
• It includes excessive day time
sleepiness, sleep attacks during
day time, sleep drunkenness
• (Confusional arousals, also
known as sleep drunkenness ,
consist of mental confusion or
confusional behavior during or
following arousals from sleep).

27. Causes of hypersomnia
• Narcolepsy
• Sleep apnea:Repeated episodes of apnea during sleep.
• Kleine-Levin syndrome:Periodic episodes of
hypersomnia.
• Not getting enough sleep at night (sleep deprivation)
• Being overweight
• Drug or alcohol abuse
• A head injury or a neurological disease, such
as multiple sclerosis
• Prescription drugs, such as tranquilizers
• Genetics (having a relative with hypersomnia)

28. 1. Narcolepsy: Excessive daytime sleepiness
characterized by:
• Sleep attacks
• Cataplexy- sudden decrease or loss of muscle tone, may
lead to sleep.
• Sleep paralysis – it occurs either at awakening in the
morning or at sleep onset. The person is conscious but
unable to move his body.
• Hypnogogic hallucination -hallucination occur at the
transition from wakefulness to sleep

29. Symptoms of hypersomnia:
• Feeling unusually tired all the time
• The need for daytime naps
• Feeling drowsy, despite sleeping and napping –
not refreshed on waking up
• Difficulty thinking and making decisions – the
mind feels ‘foggy’
• Apathy
• Memory or concentration difficulties
• An increased risk of accidents, especially motor
vehicle accidents.

30. Self-help strategies
• Avoid cigarettes, alcohol and caffeinated drinks near bedtime.
• Follow a relaxation routine to prevent night-time anxiety.
• Exercise regularly and maintain a normal weight for your
height.
• Eat a well-balanced diet to prevent nutritional deficiencies.
• If possible, change environment to reduce disturbances – for
example, don’t watch television in the bedroom.
• Be comfortable; make sure you don’t overheat or feel too cold
in bed.
• Have a regular sleeping routine so that the body ‘knows’ it is
time to sleep.
• Only go to bed when you feel sleepy.

31. Disorder of sleep- wake schedule:
The person is not able to sleep when he wishes to,
although at other time he is able to sleep
adequately.
Causes:
• Work shifts
• Unusual sleep phases

32. Stage IV sleep disorders
• Sleep walking (somnobulism)
• Night terrors : episodes of screaming, intense
fear during sleep.
• Sleep related enuresis
• Bruxism (tooth grinding)
• Sleep talking ( Somniloquy)

33. • Sleep-walking: This is a common abnormal
behaviour during sleep. The person may walk
around the house while still asleep. Sleep
walking tends to affect children more than
adults.

34. Other sleep disorders
• Nocturnal angina: Angina occurring at night. Rare
condition.
• Nocturnal Asthma: symptoms like chest tightness,
shortness of breath, cough, and wheezing at night,
can make sleep impossible and leave you feeling
tired and irritable during the day.
• Nocturnal Seizures: Nocturnal epilepsy is a seizure
disorder in which seizures occur only while sleeping.
Several common forms of epilepsy, including frontal
lobe epilepsy, can manifest in a nocturnal state.

35. Nursing diagnosis
• Disturbed sleep pattern related to lack of cues
for day- night schedule; manifested by erratic
sleep schedule, frequent naps and nocturnal
wandering

36. Nursing interventions
• offer meals at regular times, corresponding to client’s
previous pattern
• provide active meaningful activities during daytime hours,
including exposure to natural light, and an outdoor
environment when possible
• monitor frequency and duration of naps
• create an individualized bedtime ritual that includes a
quieting activity, a light carbohydrate snack, going to the
bathroom and settling a routine
• Do not wake even if incontinent. Change and assist the client
to the bathroom when he or she spontaneously awakens
• if turning or other care is necessary, try to provide for periods
up to 2 hours of undisturbed sleep time whenever possible