This document discusses sleep patterns and disturbances. It defines sleep as a state of decreased awareness and responsiveness characterized by changes in physiology and brain activity. Nearly a third of people experience some form of sleep disturbance. There are various stages of non-REM and REM sleep characterized by different brain wave patterns and levels of arousal. Many factors can influence sleep including medical, lifestyle and environmental factors. Common sleep disorders include insomnia, sleep apnea, narcolepsy and parasomnias. Diagnosis involves tools like polysomnography and treatment aims to address the underlying causes.

1. SLEEP PATTERN AND ITS
DISTURBANCES

3. INTRODUCTION
Nearly one third of our life is spent in sleep. Every
day we voluntarily go to bed and transit into an easily
reversible state of relative unresponsive and
tranquility. This state occurs almost regularly and
repetitively each day. Sleep has long been assumed
to have restorative function and recently many
people believed sleep to be a passive state of
decreased stimulation.

4. DEFINITION
Sleep can be defined as state of consciousness
characterized by decreases in awareness and
responsiveness to stimuli. Sleep is distinguished
from consciousness by being readily reversible.

5. INCIDENCE
Almost a third of the general population has some
problems with sleep during any given year. More
than half of the 9000 participants in a study of sleep
in elderly persons (65 years or older) reported the
following as sleep pattern disturbance that they
experience most of the time:

6. CIRCADIAN CYCLE

7. PHYSIOLOGY OF SLEEP

8. STAGES OF SLEEP
POLYSOMNIGRAPHIC PROFILES TWO STATES OF SLEEP
 RAPID EYE MOVEMENT SLEEP OR D- SLEEP
(DESYNCHRONIZED SLEEP OR DREAMING SLEEP OR
ACTIVE SLEEP
 NON-RAPID EYE MOVEMENT SLEEP (NREM), OR S-
SLEEP (SYNCHRONIZED SLEEP) PR QUITE SLEEP OR
ORTHODOX SLEEP.

9. NREM DEVISION OF SLEEP
STAGE I
STAGE II
STAGE III
STAGE IV

10. STAGE I
 includes lightest level of sleep
 stage lasts a few minutes
 decreased physiological activity begins with gradual fall in
vital signs and metabolism
 sensory stimuli such as noise, easily arouse sleeper
 if awakened, person feels as though daydreaming has
occurred

11. STAGE II
 includes period of sound sleep
 relaxation progresses
 arousal is still relatively easy
 stage lasts 10 – 20 mts
 body functions continue to slow
 the brain waves are frequently mixed and low voltage in
pattern, with bursts of activity called sleep spindles and large
amplitude waves called K complexes

12. STAGE III
 it involves initial stages of deep sleep
 sleeper is difficult to arouse and rarely moves
 oxygen consumption
 muscles are completely relaxed
 vital signs decline, but remain regular
 stage lasts 15 – 30 mts

13. STAGE IV
 it is deepest stage of sleep
 it is very difficult to arouse sleeper
 If sleep loss has occurred, sleeper will spend considerable
portion of night in this stage.
 Vital signs are significantly lower than during waking hours
 Stage lasts approximately 15 – 30 mts
 Sleep walking and enuresis sometimes occur
 Stage 3 and 4 known as slow wave sleep, named for the
characteristic high voltage and low – frequency delta waves

14. SLEEP CYCLE

15. FUNCTION OF SLEEP
It is a time of restoration and preparation for the next
period of wakefulness
During NREM stage 4 body releases human growth
hormone for the repair and renewal of epithelial and
specialized cells such as brain cells
Protein synthesis and cell division for the renewal of
tissues occur during rest and sleep
REM sleep appears to be important for cognitive
restoration

16. NORMAL SLEEP REQUIREMENT
 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

17. FACTOERS AFFECTING SLEEP
A number of factors affect the quality and quantity of sleep. Often more
than one factor combined to cause a sleep problem.
 Physical illness (eg. Nausea, mood disorders, breathing difficulty, pain)
 Drugs and substances (eg. Tryptophan)
 Lifestyle (eg. Daily routines, exercises)
 Usual sleep patterns and excessive daytime sleepiness
 Emotional stress
 Environment ( ventilation)

18. Continue…
Sound
Exercise and fatigue
Food and caloric intake

19. ICD 10 SLEEP DISORDER
CLASSIFICATION
 G47 Sleep disorders
 G47.0 Insomnia
 G47.00 …… unspecified
 G47.01 …… due to medical condition
 G47.09 Other insomnia
 G47.1 Hypersomnia
 G47.10 …… unspecified

20.  G47.10 …… unspecified
 G47.11 Idiopathic hypersomnia with long sleep time
 G47.12 Idiopathic hypersomnia without long sleep time
 G47.13 Recurrent hypersomnia
 G47.14 …… due to medical condition
 G47.19 Other hypersomnia
 G47.2 Circadian rhythm sleep disorders
 G47.20 Circadian rhythm sleep disorder, unspecified type

21.  G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
 G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
 G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
 G47.24 Circadian rhythm sleep disorder, free running type
 G47.25 Circadian rhythm sleep disorder, jet lag type
 G47.26 Circadian rhythm sleep disorder, shift work type
 G47.27 Circadian rhythm sleep disorder in conditions
classified

22. elsewhere
 G47.29 Other circadian rhythm sleep disorder
 G47.3 Sleep apnea
 G47.30 …… unspecified
 G47.31 Primary central sleep apnea
 G47.32 High altitude periodic breathing
 G47.33 Obstructive sleep apnea (adult) (pediatric)
 G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation

23.  G47.35 Congenital central alveolar hypoventilation syndrome
 G47.36 Sleep related hypoventilation in conditions classified elsewhere
 G47.37 Central sleep apnea in conditions classified elsewhere
 G47.39 Other sleep apnea
 G47.4 Narcolepsy and cataplexy
 G47.41 Narcolepsy
 G47.411 …… with cataplexy

24.  G47.419 …… without cataplexy
 G47.42 Narcolepsy in conditions classified elsewhere
 G47.421 …… with cataplexy
 G47.429 …… without cataplexy
 G47.5 Parasomnia
 G47.50 …… unspecified
 G47.51 Confusional arousals
 G47.52 REM sleep behavior disorder
 G47.53 Recurrent isolated sleep paralysis

25.  G47.54 …… in conditions classified elsewhere
 G47.59 Other parasomnia
 G47.6 Sleep related movement disorders
 G47.61 Periodic limb movement disorder
 G47.62 Sleep related leg cramps
 G47.63 Sleep related bruxism
 G47.69 Other sleep related movement disorders
 G47.8 Other sleep disorders
 G47.9 Sleep disorder, unspecified

26. SLEEP DISORDER
Sleep pattern disturbance is a nursing diagnosis that
is defined as a disruption of sleep time that causes
discomfort or interferes with a desired life cycle. A
sleep pattern disturbance may be related to one of
more than 80 sleep disorders identified in the
international classification of sleep disorders, a partial
list of which is given below:

27. The Dyssomnias include sleep disorders characterized
by difficulty in initiating or maintaining sleep (insomnia)
or by excessive sleepiness. These disorders may arise
predominantly from within the body (intrinsic), from
external sources (extrinsic), or from disruption of
circadian rhythm.
INTRINSIC SLEEP DISORDER
EXTRINSIC SLEEP DISORDER
1. DYSSOMNIAS

28. INTRINSIC SLEEP DISORDER
1. INSOMNIA
2. NACRCOLEPSY
3. SLEEP APNEA SYNDROME
a) OBSTRUCTIVE SLEEP APNEA
b) CENTRAL SLEEP APNEA SYNDROME
4. PERIODIC LIMB MOVEMENT DISORDER
5. RESTLESS LEG SYNDROME

29. EXTRINSIC SLEEP DISORDER
1.CIRCADIAN RHYTHM SLEEP DISORDER
2.PARASOMNIAS
a.AROUSAL DISORDER
b.SLEEP-WAKE TRANSITION DISORDERS
c. PARASOMNIAS USUALLY ASSOCIATED WITH REM
SLEEP
d.OTHER PARASOMNIAS

30. 3.SLEEP DISORDES ASSOCIATED WITH
MEDICAL OR PSYCHIATRIC DISORDERS
A. NEUROTRANSMITTER IMBALANCES
B. HEAD INJURY
C.HORMONAL IMBALANCES
D.RESPIRATORY DISORDERS
E. CARDIOVASCULAR DISORDERS
F. GASTROINTESTINAL DISORDERS
G.OTHER DISORDERS

31. G.OTHER DISORDERS
Numerous Other disorders such as, skin conditions (atopic
eczema), fibromyalgia, and seizures seem to have an effect on
or an association with sleep.

32. 4.HOSPITAL ACQUIRED SLEEP DISTURBANCES
A.SLEEP ONSET DIFFICULTY
B.SLEEP MAINTENANCE DISTURBANCE
C.EARLY MORNING AWAKENING
D.SLEEP DEPRIVATION

33. ASSESSMENT AND MANAGEMENT
Diagnostic assessment:
Polysomnography
Electroencephalogram
Multiple sleep latency test (MSLT)

34. MSLT is performed to assess the impairment of
daytime alertness. It is performed a day after a
standard polysomnogram. The time required for
clients to fall asleep when in a relaxed state is
evaluated at 2 hour intervals, with each nap limited
to 20 minutes. The type of sleep also is assessed.

35. SLEEP MEASUREMENT
 Electroencephalogram (EEG) measures the electrical
changes in the brain. The electrodes are placed on the scalp.
The wavy lines recorded by the EEG are called brain waves.
 Electrooculogram (EOG) measures the electrical changes
as the eyes rotate in its socket. The electrodes are placed
either above and below the eye or left and right of the eye.

36. Electromyogram (EMG) measures the electrical
changes generated during muscle contraction. The
electrodes are placed under the chin.
EEG, EOG and EMG are recorded simultaneously
and the patterns of activity in these three systems
provide basic classification for the different types of
sleep.

37. SLEEP MEASUREMENT TOOL
National Sleep Foundation’s Sleep Diary
The National Sleep Foundation’s Sleep Diary is easy to use
and takes just a few minutes each day to complete. It asks
about things that can help, or hinder, a good night’s sleep,
including the person’s bedroom environment, sleep habits,
and caffeine consumption. Completing the Sleep Diary every
morning and evening for a week or more captures valuable
information that assists individuals and their health care
providers to identify patterns and practices that foster.

39. THANK YOU FOR
CONCENTRATING
WITHOUT FALLING
ASLEEP!!!