sleep stages and disorders mainly insomnia

2. SLEEP DISORDERS

3. Goal
At the end of the seminar, students will be
able to gain the knowledge regarding sleep
disturbances & its patterns & apply this
knowledge into providing care to the client.

4. Objectives
At the end of the seminar student will be able to:
*Define sleep.
*Enlist the factors affecting the sleep.
*Discuss about the stages of sleep briefly.
*Explain the short term consciquences of sleep.
*Explain sleep disorder and its management.
*Discuss nursing management of sleep disturbances.
*Explain role of nurse.

5. Facts
**Man is the only mammal that willingly
delays sleep.
**Divorced, widowed and separated people
report more insomnia.
**Parents of new babies miss out on 6
months worth of sleep in the first 2 years of
their child's life.

6. **Before alarm clocks were invented,
there were "knocker-ups" who went
tapping on client's windows with long
sticks until they were awake.
**Dysania is the state of finding it
hard to get out of bed in the morning.
Facts : cont’d

7. What is sleep?
“highly structured and well-organized
activity
following a circadian periodicity that is
regulated by the
interplay of internal biological processes
and environmental
factors.”

8. Physiology of sleep
There are two types of sleep, non-rapid eye movement
(NREM) sleep and rapid eye movement (REM) sleep.
NREM sleep is divided into stages 1, 2, 3, and 4,
representing a continuum of relative depth. Each has
unique characteristics including variations in brain wave
patterns, eye movements, and muscle tone.
Circadian rhythms, the daily rhythms in physiology and
behavior, regulate the sleep-wake cycle.

9. Sleep stages
Usually sleepers pass through five stages: 1, 2, 3, 4
and REM (rapid eye movement) sleep. 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. The first sleep cycles
each night have relatively short REM sleeps and long
periods of deep sleep but later in the night, REM
periods lengthen and deep sleep time decreases.

10. Stage 1
Stage 1 is light sleep where you drift in and out of
sleep and can be awakened easily. In this stage,
the eyes move slowly and muscle activity slows.
During this stage, many people experience sudden
muscle contractions preceded by a sensation of
falling.

11. Stage 2
eye movement stops and brain
waves become slower with only an
occasional burst of rapid brain
waves

12. Stage 3
extremely slow brain waves called delta
waves are interspersed with smaller, faster
waves

13. Stage 4
The brain produces delta waves almost
exclusively. Stages 3 and 4 are referred to
as deep sleep or delta sleep, and it is very
difficult to wake someone from them. In deep
sleep, there is no eye movement or muscle
activity. This is when some children experience
bedwetting, sleepwalking or night terrors. In 2008
the sleep profession in the US eliminated the use
of stage 4. Stages 3 and 4 are now considered
stage 3

15. REM stage
In the 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. Also,
heart rate increases, blood pressure rises, and
the body loses some of the ability to regulate its
temperature.

16. REM :Cont’d
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.

18. Categories of sleep disorders
There are four major categories of sleep disorders
according to the Sleep Disorders Classification
Committee of the American Academy of Sleep
Medicine:
1. Disorders of initiating and maintaining
sleep(insomnias).
2. Disorders of the sleep–wake cycle.
3. Dysfunctions associated with sleep, sleep stages, or
partial arousals (parasomnias).
4. Disorders of excessive somnolence.

19. Insomnia
difficulty falling asleep or
maintaining sleep

20. Predisposing factors
A*The predisposing factors for insomnia are related to
the internal stress
response mechanisms of the awakening system. They
include—the hyperactivity of the hypothalamic-pituitary-
adrenal axis, abnormalities in the circadian rhythm or
internal clock regulating circadian sleep wakefulness,
depression, and anxiety.

21. B*Biological
a) Age
b) Female gender
c) Hormonal factors such a melatonin
d) Hyper arousal influences
Predisposing factors : cont’d

22. Precipitating factors
a. Precipitating factors of insomnia are associated with
social cues, behavioral response to the environment and
individual cognitive characteristics. Examples of
precipitating factors include:
i. Conditions affecting sleep which may include pain and
discomfort that affects sleep and energy levels
ii. Medications that affect sleep
iii. Change in sleep environment including noise levels,
lighting,
temperature, and setting, which may alter sleep
iv. Rotating work schedules
b. Psychological stressors also contribute to precipitating
factors and
response.

23. Assessment of Insomnia
B*evaluations of the sleep environment and sleep
hygiene.
A*complete medical, psychological, and social
Assessment.

24. Interventions
A*Cognitive behavior therapy (CBT) for acute and
chronic insomnia provided by psychiatric clinical nurse
specialist, or psychologist is the gold standard
treatment for insomnia
B*The use of pharmacological agents may also benefit
both acute and chronic types of insomnia
**hypnotic drugs, which induce sleep.
**Other medications are also used for their
sedating side effects such as anti-psychotics

25. General sleep Habits
recommendations
• Emphasis placed on maintaining a regular sleep
schedule 7 days per week during the night to promote
rest for the patient & the family
• Encourage gentle, regular, stretching, exercise as
tolerated. Do not exercise 2-3 hours before bed.
• Suggestions to create a calm environment
○ Ensure a quiet & dark sleep room as preferred.
Encourage use of earplugs or head phones
○ Employ white noise (e.g., sound machines, fans, MP3
player, radio with soothing music or sounds)
○ Refrain from watching television in bed, especially
prior to sleep
○ Avoid alcohol, nicotine, & caffeine later in the day &
evening

26. If unable to fall asleep within 30 minutes of going to bed,
assess for pain &/or other symptoms & treat appropriately to
promote sleep such as extra pre-bedtime dosing of
medications or oxygen therapy. Also if pain & other
symptoms awaken the patient during regular sleeping hours,
attempt a plan to decrease episodes. For example, switch to
long-acting medications for stable symptoms
General sleep Habits
recommendations

27. Disorders of the sleep-wake
cycle
Disorders of the sleep-wake cycle are characterized by a
temporal discrepancy of the circadian clock relative to the
surrounding environmental .
This may arise due to changes in external cues, as in jet lag
and shift-work sleep disorder. Equally it can originate because
of an abnormality in the timing of the body clock, the result of
which is typically chronic insomnia.

28. Sleep hygiene
‘Sleep hygiene’ is the term used to describe good sleep
habits.
Considerable research has gone into developing a set of
guidelines and tips which are designed to enhance good
sleeping, and there is much evidence to suggest that
these
strategies can provide long-term solutions to sleep
difficulties.

29. Sleep hygiene tips
1* Get regular.
2* Sleep when sleepy.
3* Get up & try again.
4* Avoid caffeine & nicotine.
5* Bed is forsleeping.
6* No naps.
7* Sleep rituals.
8* Bathtime.
9* No clock-watching.
10* Use a sleep diary.
11* Exercise.

30. Sleep hygiene
tips : Cont’d
12* Eat right.
13* The right space.
14* Keep daytime routine
the same.

31. By:
Manal Abul-Haija
raghad Naseem
Ghadeerodeh