Sleep A Basic Human Need

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Sleep

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has come to be considered an altered state of consciousness in which the individual's perception of and reaction to the environment are decreased.

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Somnology

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The study of sleep

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Cerebral cortex and Reticular formation

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Necessary for the regulation of the sleep and waking states

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Riticular Activating System[RAS]

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Darkness and proparing for sleep causes a decrease in stimulation of the RAS

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Beginning of daylight

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Melatonin is at its lowest level in the body and the stimulating hormone, Cortisol, is at its highest.

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Acetylcholine

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Acetylcholine is released in the reticular formation, dopamine in the midbrain and noradrenaline in the pons. These neurotransmitters are localized within the reticular formation and influence cerebral cortical arousal.

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Wakefulness

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Wakefulness is also associated with high levels of Acetylcholine, dopamine, and noradrenaline

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Circadian Rhythms

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Biological rhythms exist in plants, animals and humans

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Circadian Regularity

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Begins to develop by the sixth week of life, and by 3 to 6 months most infants have a regular sleep-wake cycle

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Circadian Synchronization

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the person is awake when the body temperature is highest, and asleep when the body temperature is lowest.[when a person's biological clock coincides with the sleep-wake cycles]

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Sleep Architecture

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Refers to the basic organization of normal sleep.

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There are two types of sleep

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NREM [non-rapid-eye-movement] sleep
REM [rapid-eye-movement] sleep. During sleep, NREM and REM soeep alternate in cycles.

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NREM Sleep

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Occurs when activity in the RAS is inhibited. About 75% to 80% of sleep during a night is NREM sleep.

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Stage 1 of NREM

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Very light sleep and lasts only a few minutes. Person feels drowsy and relaxed, heart and respiratory rates drop slightly. The person can be readily awakened and may deny that he or she was sleeping

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Stage 2 of NREM

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Still light sleep during which body processess continue to slow down. The eyes are generally still, the heart and respiratory rates decrease slightly and body temp. falls. Only lasts about 10-15 minutes long but constitutes 44% to 55% of total sleep

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Stage lll and lV of NREM

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These are the deepest stages of sleep, differing only in the percentage of delta waves recorded during a 30-second period. This is sometimes called Delta or Deep sleep

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Stage lll and lV of NREM

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The sleeper's heart and respiratory rates drop 20% to 30% below those exhibited during waking hours. the sleeper is difficult to arouse.Essential for restoring ENERGY and relaeasing important growth hormones

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[RAS] Reticular Activating System

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RAS is located in the brain stem with projections th the hypothalamus and cerebral cortex. The nerve fibers in the RAS relay impulses to the cerebral cortex for perception by the person.

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REM Sleep

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REM sleep usually recurs about every 90 minutes and lasts 5 to 30 minutes. Most dreams take place during REM but usually will not be remembered.

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REM Sleep

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In this phase, the sleeper may be difficult to arouse.Heart and respiratory rates often are irregular. It is thought that the regions of the brain that are used in learning, thinking, and organizing information are stimulsted during REM sleep

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Sleep cycles of NREM and REM

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Passing through NREM and REM sleep, the complete cycle usually lasting about 90 to 110 minutes in adults

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Sleep Cycles continues

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In the first sleep cycle, a sleeper usually passes through all of the first three NREM stages in about 20 to 30 minutes. Then, stage lV may last about 30 minutes

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Sleep Cycle continues

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After stage lV NREM the sleep passes back through stages lll and ll over about 20 minutes. Then the first REM stage occurs

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REM

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It is not unusual for the first REM period to be very brief or even skipped entirely.We usually experience four to six cycles of sleep during 7 to 8 hour.

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Sleep Schedule

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Newborns sleep 16 to 18 hours a day on an irregular schedule with periods of 1 to 3 hour awake,Newborns enter REM immediately.

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Infants

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Infants awaken every 3 or 4 hours, eat, and then go back to sleep. Periods or wakefulness gradually increase during the first months, By 6 months most infants sleep through the night. At the end of the first year the enfant should get about 14 to 15 hours of sleep About half of the infants sleep time is spent in light sleep.

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Toddlers

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Between 12 and 14 hours of sleep are recommended for children 1 to 3 years of age, Still need an afternoon nap. The toddler will resist going to bed.Nightime fears and nightmares are also common at this age.

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Preschoolers

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The preschool child [3 to 5 years of age] requires 11 to 13 hours of sleep per night,Many children at this age dislike bedtime. The 4 to 5 year old may become restless and irritable if sleep requirements are not met.

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School-Age Children

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[5 to 12 years of age] needs 10 to 11 hours of sleep, but most receive less because of increasing demands.They may also be spending more time at the computer and watching T..

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Clinical Alert

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Children who have a TV and/or computer in their bedroom are more likely to get less sleep

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Adolescents

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12 to 18 years of age, require 9 to 10 hours of sleep.
during Adolescents, Boys begin to experience NOCTURNAL EMMISSIONS [orgasm and emission of semen during sleep]

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Adults

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Most healthy adults need 7 to 9 hours of sleep at night.

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Elders

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Tendency toward earlier bedtime and wake times. Older adults [65 to 75 years] awaken 1.3 hours earlier and go to bed approximately 1 hour earlier. Older adults are sleeping 7 to 9 hour on both weeknights and weekends.

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Alcohol

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Alcohol disrupts REM sleep, although it may hasten the onset of sleep. While making up for lost REM sleep after some of the effects of the alcohol have worn off, people often experience nightmares.

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Dietary L-tryptophan

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found in cheese and milk- may induce sleep, a fact that might explain why warm milk- may induce sleep.

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Smoking

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Nicotine has a stimulating effect on the body, and smokers often have more difficulty falling asleep than nonsmokers do. They are usually easily aroused and often describe themselves as light sleepers.

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Antidepressants

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Suppress REM sleep, this effect is considered a therapeutic action, In fact, selectively depriving a depressed client of REM sleep will result in an immediate but transient improvement in mood.

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Medications

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Hypnotics-can interfere with deep sleep and suppress REM sleep
Beta-blockers have been known to cause insomnia and nightmares.
Narcotics, [Demerol] and morphine, are known to supreee REM sleep and to cause frequent awakenings and drowsiness. Tranquilizers interfere with REM sleep

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Hypnotic Medication and Antidepressants

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may experience a REM rebound [increased REM sleep] when these medications are discontinued.

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Obese or overweight

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Obtaining less than 7 hour sleep were significantly more likely to be obese . Subjects obtaining 5 hours of sleep were 60% more likely to be obese, and subjects obtaining 6 hours of sleep per night were 27% more likely to be obese than subject obtaining 7 hours of sleep

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Insomnia

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Described as the inability to fall asleep or remain asleep. Persons with insomnia awaken not feeling rested.

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Drugs that cause daytime sleepiness

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1] Antidepressants 2} Antihistamines 3] Beta-blockers 4] Narcotics

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Acute insomnia

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Lasts one to several nights and is often caused by personal stressors and or worry

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Chronic Insomnia

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If the insomnia persists for longer than one month

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The two main risk factors of insomnia

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Older age---Female Gender

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Antihistamines [Benadryl]

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Antihistamines should not be recommended for any client with a history of asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease, or hypertension

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Hypersomnia

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Refers to the conditions where the affected individual obtains sufficient sleep at night but still cannot stay awake during the day

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Narcolepsy

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Excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the central nervous system that regulates sleep.

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Narcolepsy

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Onset of symptoms tends to occur between ages 15 and 30

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Sleep Apnea

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Characterized by frequent short breathing pauses during sleep. More than five apneic episodes or five breathing pauses longer than 10 seconds/hour is considered abnormal and should be evaluated.

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Three common types of sleep apnea 1]Obstructive apnea, Central apnea, and Mixed apnea

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Obstructive Apnea--occures when the structures of the pharynx or oral cavity block the flow of air.The chest and abdominal muscles move. Movements of the diaphram become stronger and stronger until the obstruction is removed [inlarged tonsils,deviated nasal septum, obesity]

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Central Apnea

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Involve a defect in the respiratory center of the brain. All action involved in breathing ,such as chest movement and airflow,cease. [brain stem injuries and muscular dystrophy]

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Mixed Apnea

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Is a combination of central apnea and Obstructive Apnea

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Bruxism

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Clenching and grinding of the teeth

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Enuresis

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Bed wetting during sleep can occur in children over 3 years old . More males than females are affected.

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Somnambulism

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Sleepwalking--Tend to not notice danger [stairs] Happens during stages lll and lV of NREM

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Parasomnias

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Sleep disorders, [Subdivided parasomnia into arousal disorders] Sleepwalking, sleep terrors, sleep talking ,nightmares, bruxism

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Sleep Apnea [common findings]

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Enlarged and reddened uvula and soft palate, enlarged tonsils and adenoids, obesity, and in male clients a neck size greater than 17.5 inches

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Creating A Restful Environment

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Minimal noise, a comfortableroom temp., appropriate ventilation and appropriate lighting [nightlight if prefered].

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zolpidem 10 mg

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Perscription, for menopausal symptoms, related to bothersom sleep.

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Half life medication

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Half-life represents how long it takes for half of the medication to be metabolized and eliminated by the body, those with shorter half-life are less likely to cause residual drowsinedd after administration, but may be less effective for the treatment of sleep maintenance insomnia

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Tryptophan [Milk and protein foods

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Serotonin, which is thought to induce and maintain sleep. Stimulants should be avoided because they inhibit sleep.