Government College Of Nursing,Raipur

SLEEP DISORDERSINTRODUCTION One third of human life is spent in sleep, an easily reversible state of relative unresponsivness and serenity which occurs more or less regularly and repetitively each day. Sleep provide time for repair and recovery of body system for the next period of wakefulness.DEFINITION Sleep is a physical and mental resting state in which a person becomes relatively inactive and unaware of the enviornment DEFINITION Sleep disorders are major disturbances of normal sleep pattern that lead to distress and disrupt functioning during the day

Group of syndomes characterised by disturbance in patients amount of sleep,quality or timing of sleep or in behaviors or physiological conditions associated with sleep

PREVALANCE RATES In India women(6.5%) suffers more than men(4.3%) when it comes to disturbed sleep.

Around 4% Indian men who reported severe sleep problems suffered from severe depression while 3% reported severe anxiety.FUNCTIONS OF SLEEPIt is a time of restoration and preparation for the next period of wakefulnessDuring NREM stage 4 body releases human growth hormones for the repair and renewal of epithelial and specialised cells such as brain cells.Protein synthesis and cell division for the renewal of tissues occur during rest and sleep4. REM sleep appears to be important for cognitive restoration.

5. Psychological Function:- Sorting and discarding of neurophysiologic dataCharacter Reinforcement & Adaptation Physiology Of SleepStages Of Sleep Stage 1 NREM Sleep: It is transitional stage between drowsiness and sleep.Stage 2 NREM Sleep: It is beginning of true sleep.Stage 3 & 4 NREM Sleep: These are the deepest level of human sleep Rapid Eye Movement Sleep: It makes 20% of our sleep time and in this stage we experience vivid dreams.Factors Affecting Sleep

Physical ActivityPsychologic StressDietAlcohol IntakeSmokingChange in Enviornmental ConditionsLifestyleIllnessMedicationsSleep Disorders

The major diagnostic categories are:DysomniasParasomniasMedical/Psychaitric Sleep disorderProposed Sleep DisorderDysomniasIntrinsic Sleep DisordersPrimary Insomnia:- Difficulty in falling asleep or remaining asleep that lasts for atleast one monthPrimary Hypersomnia:- A condition marked by excessive sleepiness during normal waking hours.iii) Narcolepsy :- A dysfunction of REM sleep process and of mechanism regulating alteration between sleep and awakened states during the day time.iv) Breathing Related Sleep DisorderB) Extrinsic Sleep DisorderC) Circadian Rhythm Sleep Disorder

B) Extrinsic Sleep Disorder: Those sleep disorder that occur secondary to environmental conditions or various pathological conditions like inadequate sleep hygiene, environmental sleep disorder, food-allergy insomnia, alcohol dependent sleep disorderInsufficient sleep syndrome, Nocturnal eating(drinking) syndrome.

C) Circadian rhythm sleep disorder: results from a discrepancy between the person's daily sleep/wake patterns and demands of social activities, shift work, or travel. results from a discrepancy between the person's daily sleep/wake patterns and demands of social activities, shift work, or travel2. Parasomnias Parasomnias: primary sleep disorders in which the patient's behavior is affected by specific sleep stages or transitions between sleeping and waking. They are sometimes described as disorders of physiological arousal during sleep.A. Arousal Disorders- Confessional arousals, Sleep Walking, Sleep TerrorsB. Sleep-wake transition disorder- Rhythmic movement disorder, sleep talking, Nocturnal leg crampsC. Parasomnias usually associated with REM sleep- Nightmares, Sleep paralysis, sleep related painful reactions

3 . Medical/Psychiatric Sleep Disorder:Associated with mental disorder- psychosis, mood disorders, anxiety disorders, panic disorders and alcoholism.Associated with neurological disorders: Dementia, Parkinsonism, sleep-related epilepsy.Associated with other medical disorder: Sleeping sickness ,COPD, peptic ulcer diseaseProposed Sleep Disorder: Menstrual associated sleep disorder, Pregnancy associated sleep disorder, sleep related laryngospasm.

COMMON SLEEP DISORDERSInsomnia: Insomnia is the most prevalent sleep complaint in general population. It can be described as the inability to obtain sleep that is long enough to give a feeling of being rested or refreshed the following day

Hypersomnia: hypersomnia can be defined as excessive sleepiness or seeking excessive amount of sleep. Primary hypersomnia refers to the condition when no other cause for the symptom can be found. the term should be used for the individual who have difficulty in staying awake .Narcolepsy: Narcolepsy is a neurological disorder affecting one in 2,000 individuals. It is characterised by the tendency to fall asleep during day time, despite having obtained an adequate amount of sleep the preceding night.Parasomnias: Parasomnias are defined as the unpleasant or undesirable behavioural or the experiential phenomena that occur predominantly or exclusively during sleep.The common parasomnias result from an overlap ofawake behaviour during sleepSleep Apnea: Sleep Apnea refers to period of no breathing between snoring intervals. The person may not breathe for periods of 10 -20 seconds to as long as 2 minutes

Sleep Deprivation It refers to decrease in the amount, consistency and quality of sleep. It may result from decreased REM or NREM sleep.NURSING DIAGNOSIS Sleep pattern disturbances related to (specific medical condition); use of, withdrawal from, substances, anxiety or depression; circadian rhythm disruption; familial patterns; evidenced by insomnia, hypersomnia, nightmares, sleep terrors, or sleepwalking.

Risk for injury related to excessive sleepiness, sleep terrors, or sleepwalking

SLEEP EDUCATIONSleep hygiene" or sleep education for sleep disorders often includes instructing the patient in methods to enhance sleep. Patients are advised to:wait until client is sleepy before going to bedAvoid using the bedroom for work, reading, or watching television avoid smoking and avoid drinking liquids with caffeineGet some physical exercise early in the day every dayLimit fluid intake after dinner; in particular, avoid alcohol because it frequently causes interrupted sleepLearn to meditate or practice relaxation techniquesAvoid tossing and turning in bed; instead, client should get up and listen to relaxing music or read.Avoid stressors or distractions that may interrupt sleep.Do not waken even if incontinent changes and assist the client to the bathroom when he or she spontaneously