Slide1: SLEEP Sleep is a recurrent, altered state of consciousness that occurs for sustained periods, restoring physical health and mental well being. It is a sensory experience and can be selective Physiology of Sleep Reticular Activating System (RAS) Relays stimuli from cortex and periphery sense organs Wakefulness Brainstem Bulbar Synchronizing Region ( BSR) Supports sleep..releases seratonin Brainstem Work together to control sleep


Slide2: Hormones 1. Seratonin 2. Dopamine, 3. Norepinephrine 4. Histamine 5. GABA ??


SLEEP CYCLE: SLEEP CYCLE REM Rapid eye movement NREM Nonrapid eye movement 4 stages of NREM + REM NREM 1—2—3—4-(delta)—3—2 ----REM—2—3—4---3----2----REM


Slide5: NREM stages 1-4 Drowsy—to----deepest sleep Brain activity decreases BP, R, Heart rate decreases 3 and 4 decreases with age 4 could be absent by age 75 REM Often know as dream stage…but Increased brain activity Increased and variable BP, Heart rate, R. Increased blood flow to brain


Slide6: Cycles of sleep Typical 90-100min 80 min NREM 10 min REM REM = 25% NREM= 75% 4-6 cycles per night Adult average 7-9 hrs/night Stage 1 = 5% 2 = 50-55% 3 = 10% 4 = 10 %


Slide7: FACTORS AFFECTING SLEEP 1. Developmental—Lifespan Considerations


Slide8: Psychological Stress Anxiety …delay of onset Depression … Shortens REM Motivation Desire to stay awake ..…overcome sleepiness Opposite can occur also Need to maintain vigilance…..patients worry


Slide9: Life style Shift work…..disrupts normal circadian rhythm compromise judgment clockwise rotation best **** patients who work shifts Activity……. moderate exercise….not excessive 2 hrs before retiring( body temp drop leads to sleep) Culture….. specific nighttime rituals Dietary Habits…small protein-carbohydrate snack ( serotonin + CHO) alcohol---hasten on set, but disrupts REM caffeinated beverages…..CNS stimulant smoking….nicotine a stimulant hunger disturbs…large meals can also rapid weight loss or gain disturbs


Slide10: Antidepressants—supress REM Diuretics-----nocturia Narcotics--- supress REM Heart medications—nightmares, insomnia Some Steroids, Decongestants, Antiparkinsonian can disrupt 5. Medications Sleep Rebound Making up for lost REM……horrible nightmares


Slide11: Environmental Factors…many Strange and unfamiliar environment…hospital Individual sensitivity to noise and light, temperature Sleep alone or with another Frequent interruptions for treatments or assessments nurses need to modify…maintain rituals Illnesses Ill need more sleep…but more vulnerable Taylor..Gastric juice ( Gastric or Duodenal ulcers) MI pain Epilepsy seizures during REM


Slide12: Hypothyroidism….less NREM Hyperthyroidism…lengthens pre-sleep time, fragmented sleep Respiratory conditions…SOB, congestion Low estrogen…hot flashes etc. Need to urinate Temperature increases..less NREM and REM Pain conditions Discomfort from restricted movement Worries..nature of illness, tests, diagnosis, treatment, role changes etc.


Slide13: Impact of Sleep Pattern Disturbance S/Sx ..Sleep deprivation fatigue, headache, increased sensitivity to pain decreased neuromuscular coordination, general irritability and inability to concentrate hallucinations REM Specific Agitated Impulsive Hard to concentrate NREM Specific Withdrawn Physical complaints


Sleep Deprivation: Sleep Deprivation Worse than intoxication Build up deficit Accidents work auto 60,000 accidents 1500 fatal Poor school, work performance


Slide15: Nursing Care .....Identify interventions for the following •Assess • Comfort/ Pain Management •Bedtime Ritual/ Routines • Bedtime Snack •Scheduled Care •Diversional Activities •Pharmacological Agents •Stress Reduction •Environmental Controls


Slide16: Insomnia …difficulty falling asleep or staying asleep (intermittent or early awakening)……….. most common of sleep disorders Transient/ situational……life changes Three weeks or less may use short term hypnotics Chronic …..often related to psychiatric cause Treat underlying cause Insomnia related to drugs…. i.e. ETOH Classifications:


Nocturnal Myoclonus – “Restless leg syndrome”: Nocturnal Myoclonus – “Restless leg syndrome” Urge to walk….irritating ache or “ creepy feeling” in calves and thighs 12 million …common in elderly 300-1000 leg jerks reported RLS may be associated with nerve damage in the legs due to diabetes, kidney problems or alcoholism.  RLS can be a side effect of a pinched nerve root from arthritis in the lower back (sciatica).  RLS may be inherited. Stress, diet may play a role in RLS.  Pregnancy or hormonal changes may temporarily worsen. symptoms


Hypersomnia: Hypersomnia Excessive sleep especially during the day Medical condition or Frequently a coping mechanism to avoid a problem


Narcolepsyuncontrollable desire to sleep with or without warning signs\: Narcolepsy uncontrollable desire to sleep with or without warning signs\ Almost immediately experience REM sleep …several minutes to 1/2 hr., different times of day Demonstrated genetic link….8-12% have first degree relative with it Common between 10-25 years and last life time Cataplexy---sudden weakness and hypotonia Sleep paralysis--inability to move especially the limbs Hallucinations--- vivid visual and or auditory Treat with medications , short naps during day Stimulants (provigil,ritalin) antidepressants (effexor, prozac)


Sleep Apnea: Sleep Apnea A self limiting episode of non-breathing during sleep Potentially lethal Occur at any age, both sexes 25% of those over  65 Apneic events 15 seconds to two minutes 20-30 apneic events per hour


Physiology of Apnea: Physiology of Apnea Period of Apnea…... in oxygen level of the blood Pulse becomes irregular and BP may  The  in circulating oxygen alerts the brain receptors ……... …..awakens sleeper to breathe……...often loud gasp Two types of Apnea Central Sleep Apnea Obstructive Sleep Apnea


Central Sleep Apnea: Central Sleep Apnea Reflects some malfunction of the central nervous system Neurological failure to trigger respiratory effort ……... diaphragm and other chest muscles stop working Commonly seen with conditions such as Stroke, brain stem injury Characteristically occurs in REM sleep


Obstructive Sleep Apnea: Obstructive Sleep Apnea Most common type……1-4% population Risk Factors: obesity smoking excessive alcohol intake Often middle ages men….but also post menopausal females Hypnotics, alcohol or antihistamines very dangerous Reduces responsiveness to  oxygen in blood


Obstructive apnea: Obstructive apnea Throat muscles and tongue relax and partially block airway Breathing noisy, labored….snoring often occurs “uncorking” noted as pressure builds up Symptoms: Sleep apnea Night time snoring Day time sleepiness, inattentiveness, impaired memory


Obstructive apnea: Obstructive apnea Danger: During periods when blood oxygen low …pulse becomes irregular cardiac arrhythmias can be fatal Some people have mix of both types


Treatments :: Treatments : Surgery… uvulectomy, part of soft palate and tonsils laser assisted pharygoplasty somnoplasty ( hi frequency radio waves) Other… dental splints


Slide27: C-pap Constant positive air pressure


Parasomnias: Parasomnias Patterns of wake behavior that appear during sleep ……... not really difficulty with sleep itself Somnambulism sleep walking and talking Bruxism grinding teeth ….damaged teeth & jaw Enuresis bed wetting during sleep1-3% of adults…..70 % mentally impaired


Slide29: The end!!!!