Primary sleep disorders: Primary sleep disorders are those disorders not attributable to another cause, which includes dyssomnias and parasomnias. Dyssomnias: are primary disorders of initiating or maintaining sleep/ excessive sleepiness, characterized by abnormalities in the amount, quality, or timing of sleep. Insomnia: Difficulty initiating or maintaining sleep or nonrestorative sleep that lasts for 1 month and causes significant distress or impairment in social, occupational, or other important areas of functioning. Hypersomnia: Excessive sleepiness for atleast 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in social, occupational or other functioning. Narcolepsy: A rare sleep disorder in which a person, usually under the age of 20, has recurrent sudden episodes of irresistible sleep attacks of short duration 10 - 15 minutes (directly enters into REM sleep). Breathing related sleep disorder: Sleep disruption leading to excessive sleepiness or, less commonly, insomnia, caused by abnormalities in ventilation during sleep. These disorders include obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of sventilation without airway obstruction), and central alveolar hypoventilation (hypoventilation resulting in low arterial oxygen levels). Circadian Rhythm Sleep Disorder: Persistent or recurring sleep disruption resulting from altered functioning of circadian rhythm or a mismatch between circadian rhythm and external demands. Subtypes include; delayed sleep phase, jet lag, shift work and unspecified. Delayed sleep phase: A persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time. Jet lag: Sleepiness and alertness that occur at an inappropriate time of day relative to local time, occurring after repeated travel across more than one time zone. Shift work: Insomnia during the major sleep period or excessive sleepiness during the major awake period associated with night shift work or frequently changing shift work. Parasomnias: are disorders characterized by abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep–wake transition. These disorders involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times during sleep. Nightmare disorder: Repeated occurrence of frightening dreams that lead to waking from sleep. Sleep terror disorder: Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry. Sleepwalking disorder (Somnambulism): Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around.

2. JUHIN. J
2ndYear Msc(N)

3. OBJECTIVES:
At the end of this session, you’ll have clear understanding about;
 What is meant by sleep
 Sleep process
 Stages of sleep
 Functions of sleep
 Epidemiology of sleep disorder
 Classification of sleep disorder
 Nursing process for sleep disorder

4. SLEEP
 Sleep is a necessary part of human functioning. Nearly
one third of human life is spent in sleep.
 New born babies need roughly 14-17 hours of sleep per
day, while teenagers require 8-10 hrs each night. Most
adults need 7-9 hrs of sleep.
 High altitudes can have a negative impact on sleep
quality.
 Sleep is defined as a normal, reversible, recurrent state
of reduced responsiveness to external stimulation that
is accompanied by complex and predictable changes in
physiology.
 Hypnogogic – wakefulness to sleep
 Hypnopompic – sleep to wakefulness

5. SLEEP PROCESS
Sleeping and waking periods are controlled by two body process.They are;
 Sleep/wake homeostasis
 Circadian biological clock.
Internal clock of our body is controlled by an area of the brain called the
Suprachiasmatic nucleus, located in hypothalamus.
Cortisol –Wakeup
Melatonin - Sleep

6. STAGES OF SLEEP

7. STAGE 1 NREM
 This stage is the first and the lightest
stage of sleep.
 This stage generally lasts for few minutes.
 During this stage, the person won’t
perceive that they were asleep; eye
movements are typically slow and rolling;
heartbeat and breathing slow down;
muscle begin to relax.

8. STAGE 2 NREM
 This stage follows stage 1 within a few
minutes.
 It comprises the largest percentage of total
sleep time and is considered as a lighter stage
of sleep from which a person can be awakened
easily.
 This is the stage before you enter into deep
sleep.
 During this stage, the person’s heartbeat and
breathing slow down further; no eye
movements; body temperature drops.

9. STAGE 3 NREM
 This stage is the deepest stage of sleep.
 During this stage, the person’s heartbeat
and breathing are at their slowest state;
no eye movements; body is fully relaxed;
arousal from sleep is difficult; tissue repair,
growth, cell regeneration occurs; immune
system strengthens.

10. REM SLEEP
 NREM-sleep is followed by REM-sleep, which
is a light phase of sleep.
 It occurs about 90 minutes after a person fall
asleep, and is the primary “dreaming” stage of
sleep.
 The characteristic features of the REM-sleep
are presence of rapid eye movements,
muscular atony, penile erection, autonomic
hyperactivity (increase in pulse rate,
respiratory rate and blood pressure), and
movements of small muscle groups.
 Although it is a light stage of sleep, arousal is
difficult.

11. FUNCTIONS OF SLEEP
• Conservation of energy
• Restorative function of whole body(during NREM sleep) and
brain(during REM sleep)
• Improve memory, attention, creativity and decision making.
• Lower rates of illness.

12. SLEEP DISORDER
Sleep disorder is defined as problems with
the quality, timing, and amount of sleep, which
result in daytime distress and impairment in
functioning.
- American Psychiatric Association

13. EPIDEMIOLOGY
• The prevalence of sleep disorder among Indian population is 93%.
• Nearly, 83.4% of the population had some type of sleep disorder.
• The incidence of sleep apnea was observed to be 34% that can result in
obesity and cardiovascular diseases in the future.

14. CLASSIFICATION – SLEEP DISORDER
Sleep disorders are organized into four categories;
• Primary sleep disorders
• Sleep disorder related to psychiatric disorders
• Sleep disorder due to general medical conditions
• Substance-induced sleep disorder

15. CLASSIFICATION – SLEEP DISORDER CONT
• Primary sleep disorders
➢ Dyssomnias
o Insomnia
o Hypersomnia
o Narcolepsy
o Breathing related sleeping disorder (Sleep apnea)
o Circadian rhythm sleep disorder
➢ Parasomnias
o Nightmare disorder
o Sleep terror disorder
o Sleepwalking disorder

16. DISSOMNIAS
Insomnia
• Pharma – Benzodiazepines, Benzodiazepine receptor agonists, Melatonin receptor
agonists
• Non Pharma- Stimulus controlT, Sleep restrictionT, CognitiveT
Hypersomnia
• Pharma – Stimulant components, Antidepressants
Narcolepsy
• Pharma – wake promoting meds, cataplexy, sleep paralysis
Breathing related sleep disorder
• Nursing – CPAP during sleep
• Surgical –Tracheostomy
Circadian rhythm sleep disorder – delayed sleep phase, jet lag, shift work
• Melatonin, bright light therapy

17.  Nursing management (SLEEP HYGIENE)
o Establish a regular schedule for going to bed and arising.
o Minimize daytime napping.
o Listening to soft music can help in some situations.
o Avoid fluid intake and heavy meals just before bedtime.
o Avoid caffeine intake before sleeping hours.
o Avoid regular use of alcohol
o Avoid reading, watching television/ mobile while in bed.
o Do not look at the clock while lying on bed.
o Sleep in a dark, quiet, and comfortable environment.
o Take care of environmental disruptions (pets or snoring partner)
o Try relaxation techniques

18. PARASOMNIAS
Nightmare disorder
• Non Pharma- Psycho therapy, Desensitization
Sleep terror disorder
• Pharma – Benzodiazepines
Sleep walking disorder
• Pharma – Benzodiazepines, Antidepressants
• Nursing- Safety, doors, windows, stairs closed

19. SLEEP DISORDER- PSY. DISORDER
• Sleep disorders related to psychiatric disorder may involve insomnia or
hypersomnia.
• Mood disorders, anxiety disorders, schizophrenia and other psychotic
disorders are often associated with sleep disturbances.
• Treatment of the underlying psychiatric disorder is indicated to resolve
the sleep disorder.

20. SLEEP DISORDER- MED. CONDITIONS
• Sleep disorder due to a general medical condition may involve
insomnia, hypersomnia, parasomnias, or a combination of these
attributable to a medical condition.
• These sleep disturbances may result from degenerative neurological
illnesses, cerebrovascular disease, endocrine conditions, viral and
bacterial infections, coughing, or pain.
• Sleep disturbances of this type may improve with treatment of the
underlying medical condition or may be treated symptomatically with
medication for sleep.

21. SLEEP DISORDER- SUBSTANCE INDUCED
• Substance-induced sleep disorder involves prominent disturbance in
sleep due to the direct physiologic effects of a substance such as
alcohol, other drugs or toxins.
• Insomnia and hypersomnia are most common.
• Treatment of the underlying substance use or abuse generally leads to
improvement in sleep.

22. NURSING PROCESS
1. Disturbed sleep pattern related to, use/withdrawal from substances; anxiety or depression; circadian
rhythm disruption; familial patterns; or specific medical condition.
Nursing Interventions:
o Encourage activities that promote sleep, hearing soft music, relaxation exercise, warm bath.
o Discourage strenuous exercise within 1 hr of bedtime.
o Control intake of caffeine containing substances(coffee, tea, colas, chocolate) within 4hrs of
bedtime.
o Before bedtime, take carbohydrate rich foods.
o Instruct the patient, not to use alcoholic beverages to relax.
o Discourage smoking and use of tobacco products before sleep.
o Discourage day time napping.
o Administer medications as per order.

23. NURSING PROCESS
2. Risk for injury related to, excessive sleepiness, sleep terrors or sleep walking.
Nursing Interventions:
o Ensure that siderails are up on the bed.
o Keep the bed in low position
o Keep a night light on, arrange the furniture in the bedroom in a manner that
promotes safety.
o Administer medications as per order.

25. ASSIGNMENT
“Sleep disorders and Neurotransmitters”

26. SUMMARY

27. REFERENCES
Books:
Mary C.Towsend.(2015). Psychiatric Mental Health Nursing (8th ed.). P. 880
Neeraj Ahuja.(2011).A short textbook of Psychiatry. P. 133-141
Sheila L.Videbeck.(2015). Psychiatric - Mental Health Nursing (5th ed.). P. 494,495
Subash Indra Kumar.(2014). Psychiatry and Mental Health Nursing. P. 467-475
Journals:
Advances in Intelligent Systems and Computing, Sleep Disorders Prevalence Studies in Indian
Population,Vol 1182, 2020
Asian Journal of Psychiatry, Prevalence of sleep disorders and severity of insomnia in psychiatric
outpatients attending a tertiary level mental health care facility, 2018
Internet:
https://www.news-medical.net/health/Function-of-Sleep
https://www.psychiatry.org/patients-families/sleep-disorders
https://www.hopkinsmedicine.org/health/conditions-and-diseases/sleepwake-cycles
https://www.healthline.com/health/healthy-sleep/stages-of-sleep