FUNDA RLE: SLEEP

• Sleep


  A basic human need, a universal biological process common to all individuals, an alteration in a person's state of consciousness in which their ability to recognize and respond to stimuli is reduced
• Sleep


  • Enhances daytime functioning and is vital for cognitive, physiologic, and psychosocial function
  • Exerts physiologic effects on both the nervous system and other body structures
  • Restores normal levels of activity and normal balance among parts of the nervous system
  • Needed for protein synthesis to facilitate repair process
• Wakefulness and sleep

  • Wakefulness is maintained and mediated by some stages of sleep
  • Sleep is an active process involving the RAS and a dynamic interaction of neurotransmitters
• Serotonin


  A major neurotransmitter associated with sleep, derived from its precursor Tryptophan, decreases activity of RAS, thereby inducing and sustaining sleep
• Serotonin, GABA, Acetylcholine, Dopamine, Noradrenaline


  Neurotransmitters involved in sleep-wake regulation
• Exposure to darkness (and preparing for sleep)


  Reduces stimulation of the RAS
• Melatonin


  When secreted by the pineal gland, it reduces alertness
• Growth hormone


  Increased during sleep
• Cortisol


  Inhibited during sleep and highest during the beginning of daylight
• Biorhythms


  Rhythmic biologic clocks that exist in plants, animals, and humans, controlled from within the body and synchronized with environmental factors such as light and darkness, gravity and electromagnetic stimuli
• Circadian rhythm


  The most familiar biorhythm, meaning "about a day"

  
• Sleep stages


  Very light sleep, Drowsiness, Light sleep, Deep sleep, REM sleep
• Sleep stages


  1. Very light sleep: Relaxation, rolling of eyes, pulse/respiratory rate drops slightly, easily awakened

  2. Light sleep: Continuous slowing down of body processes, eyes steady, pulse/respiratory rate slightly reduced, reduced temperature, needs more intense stimuli to awaken

  3. Deep sleep: Deepest stage, important for restoring energy and secretion of growth hormones, pulse/respiratory rates drop 20-30%, relaxed muscles, reduced reflexes, hard to awaken

  4. REM sleep: High brain activity and metabolism, distinctive eye movements, extremely reduced voluntary muscle tone, absent deep tendon reflexes, increased gastric secretion, irregular pulse and respiratory rates, dreaming, difficult to awaken or may wake spontaneously
• Infant sleep


  • Awake for 1-3 hours, requires 12-18 hours of sleep
  • NREM characterized by regular respiration, closed eyes, absence of body and eye movements
  • REM has rapid eye movements, body movements, irregular respiration
  • 50% of sleep is REM
  • Awake for 3-4 hours to feed, episodes of wakefulness increase, sleeps entire night and starts to establish daytime nap pattern, 9-12 hours of sleep by end of first year
  • 20-30% of sleep is REM, about half is light sleep, exhibits activity like movement, gurgle, coughing
• Toddler sleep


  • Requires 12-14 hours of sleep, afternoon naps reduce, resists bedtime, may awaken at night, provide security object to lessen fears and nightmares, 20-30% of sleep is REM
• Preschooler sleep


  • Requires 11-13 hours of sleep, sleep requirements change with activity and growth spurts, reduce resistance to bedtime with consistent routine, restrict TV to lessen nightmares, 20-30% of sleep is REM, higher than adults but stage 1 sleep is less
• School-age child sleep


  • Requires 10-11 hours of sleep, reduce hours due to demands from school and social activities, use of computer/TV and caffeine, 8 year old requires 10 hours, 12 year old less, REM sleep reduced to 20% and decreases as child grows
• Adolescent sleep


  • Requires 9-10 hours of sleep, desire for independence leads to later bedtime, can be drowsy at times, boys have nocturnal emissions, sleep is about 20% REM
• Adult sleep


  • Requires 7-9 hours of sleep, vulnerable to sleep deprivation, biologic conditions can influence sleep, factors like stress, depression, pain, shift work, travel, and lifestyle roles can diminish sleep, flattened circadian rhythm, awakens average 6 times at night with difficulty falling back asleep, daytime napping and illness decreases nocturnal sleep, sundown syndrome can disrupt sleep
• Factors that can disrupt sleep

  • Pain or physical distress
  • Respiratory conditions
  • Gastric or duodenal ulcers
  • Endocrine disturbances
  • Noise, unfamiliar surroundings
  • Discomfort from environmental temperature, lack of ventilation
  • Light levels
  • Low levels of estrogen in women
  • Increase body temperature
  • Nocturia
  • Irregular morning and nighttime schedule
  • Inability to relax before retiring
• Factors that can disrupt sleep (continued)

  • Anxiety and depression
  • Stress
  • Caffeine containing beverages
  • Alcohol
  • Nicotine
• Weight


  Weight loss is associated with increased sleep time, weight gain is associated with reduced sleep time
• Dietary l-tryptophan


  In cheese and milk, can increase alertness in some situations
• Boredom


  Sleep often readily ensues
• Hypnotics, Beta blockers, Narcotics

  Can disrupt sleep
• Factors that can interfere with sleep

  • Noise, unfamiliar surroundings
  • Discomfort from environmental temperature, lack of ventilation
  • Light levels
  • Anxiety and depression increase norepinephrine blood level through stimulation of SNS
  • Stress increase activation of the hypothalamic pituitary adrenal (HPA) axis
  • Caffeine containing beverages stimulates CNS
  • Alcohol disrupts REM sleep
  • Nicotine has a stimulating effect on the body
  • Smokers have difficulty falling asleep, they become light sleepers
• Weight loss


  Increased sleep time
• Weight gain


  Reduced sleep time
• Dietary l-tryptophan in cheese and milk


  Include sleep
• Alertness


  Can increase in some situations
• Hypnotics


  • Interfere with deep sleep and suppress REM
• Beta blockers


  • Can cause insomnia and nightmares
• Narcotics (morphine)


  • Cause frequent awakenings & drowsiness
• Substances associated with sleep problems

  • Alcohol
  • Amphetamines
  • Antidepressants
  • Beta-blockers
  • Bronchodilators
  • Caffeine
  • Decongestants
  • Narcotics
  • Steroids
• Substances that can cause sleep problems

  • Antidepressants
  • Antihistamines
  • Beta blockers
  • Narcotics
• Sleep disorders


  Typically categorized for the purpose of research as dyssomnias, parasomnias, and disorders associated with medical or psychiatric illness
• Client's symptoms


  • May include insomnia, excessive sleepiness, and abnormal events that occur during sleep (parasomnias)
• Acute insomnia


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


  Persists for longer than one month
• Chronic-intermittent insomnia


  Individual has difficulty sleeping for a few nights followed by a few nights of adequate sleep before the problem returns