H

1. MENTAL HEALTH FOR
NURSING
SLEEP DISORDERS
BY:- KABTAMU N (BSC, MSC ICCMH)
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2. Sleep
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 Sleep is a universal behavior that has been
demonstrated in every animal species studied, from
insects to mammals.
 It is one of the most significant of human behaviors,
occupying roughly one third of human life.
 Although the exact functions of sleep are still unknown,
it is clearly necessary for survival, because prolonged
sleep deprivation leads to severe physical and cognitive
impairment and, finally, death.

3. Advantages of Sleep
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 Are energy conservation
 Restoration of cellular energy stores
 Emotional regulation
 Consolidation of memory, and
 Preservation of context in which to organize
memory of new stimuli.

4. Sleep disorders
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It is a significant problem in 10% of medical out
patients.
It is associated with:
 significant morbidity.
 Poor daytime functioning
 Injuries or deaths from motor vehicle accidents.

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The 3 Major Categories – DSM-IV
1. Primary sleep disorders
2. Sleep disorders related to another Mental Disorder.
3. Other sleep disorders.
- Due to a general medical condition
- Substance induced sleep disorder

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1.Primary Sleep Disorders
- Sleep disorders caused by an abnormal sleep wake
mechanism and often by conditioning.
- Are not caused by another mental disorder, a
physical condition, or a substance.
- Primary sleep disorder Categorized as;
* Dyssomnias
* Parasomnias

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A. Dyssomnias:
 The sleep itself is pretty normal.
 But the client sleeps too little, too much, or at the
wrong time.
 So, the problem is with the amount (quantity), or
with its timing, and sometimes with the quality of
sleep.
 divided into insomnia and hypersomnia

8. Parasomnias
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 Something abnormal occurs during sleep
itself, or during the times when the client is
falling asleep or waking up (e.g., bad dreams).
 The quality, quantity, and timing of the sleep
are essentially normal.

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1.Primary insomnia:-
Diagnosed when the chief complaint is non-
restorative sleep or difficulty in initiating or
maintaining sleep for at least 1 month.
C/C-‘not enough sleep’ ‘feeling tired’
MSE- moderate impairment of concentration and
psychomotor function.
a)Treatment - Relaxation tapes
-Sedative-hypnotic drugs. E.eg
diazepam, clonazepam for short term

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b) Non-specific measures (basic sleep hygiene)
- Use the bed for sleeping only!
- Avoid eating, reading, or watching TV in bed.
- Keep a regular bed time and wake up time
including on weekends.
- Avoid naps
- Avoid evening stimulation.
- Leave the bed and bed room if unable to fall
asleep after 15min.
- And read or perform a quiet activity ( no TV!) ;
return to bed only when sleepy.

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Sleep hyegine con’t
 Bed: Lie down only when sleepy, and sleep only
as much as necessary to feel refreshed; use the
bed for sleep only
 Time: Limit in bedtime to amount present before
the sleep disturbance;
 wake up at a regular time each day;
 avoid day time naps
 Environment: Maintain condition and avoid
excessive warm and cold.
 Substances: Limit sedatives; avoid alcohol,
tobacco near bed time

12. 12  Meal: Eat at regular times daily
 avoid large meals near bed time
 eat a light snack if angry near bed time
 Exercise: exercise regularly, but early in the
day; practice evening relaxation routines, such
as progressive muscle relaxation

13. 13 2. HYPERSOMNIA
 Falling asleep inappropriately during the day or
prolonged episodes of deep sleep.
 Diagnosed when no other cause for excessive
somnolence occurring for at least 1 month can be
found.
- Treatment-stimulant drugs
- Amphetamines taken in the morning or
early evening

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3. Narcolepsy
 Sleeping at the wrong time
 Characteristics
 Sleep intrudes into wakefulness, causing clients to
fall asleep almost instantly
 Sleep is brief but refreshing
 May also have sleep paralysis, sudden loss of
strength, and hallucinations as fall asleep or
awaken.
 Treatment: Stimulants, sometimes antidepressants,
with less success.

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3. Cataplexy
brief episodes of sudden bilateral loss of muscle tone, or
paralysis
No loss of consciousness if episode is brief.
When attack is over, the patient is completely normal
Often triggered by the following:
- Anger “
- Athletic Activity
-Excitement /Elation
- Sexual intercourse
- Fear
- Embarrassment

16. 16 4.Hypnagogic/hypnopompic Hallucinations:
- vivid perceptual experiences, either auditory or
visual, occurring at sleep onset or on awakening.
- Appear several years after onset of sleep attacks.

17. Parasomnia
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1. Nightmare Disorder
 Usually occurs in early morning when REM
sleep dominates.
 The same nightmare may recur repeatedly or
different ones may pop up three times a week.
 Stress may induce 60% of nightmares.
 Half of the cases of nightmare disorder appear
before age 10; 2/3 before age 20.
 Dreams are clearly remembered
 Drugs can trigger nightmares.

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2. Sleep Terror Disorder
Characteristics:
 Abrupt awakening from sleep, usually
beginning with a panicky scream or cry.
 Intense fear and signs of autonomic
arousal
 Unresponsive to efforts from other to calm
client
 No detailed dream recalled
 Amnesia for episode

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3. Sleep walking Disorder
Characteristics:
 Rising from bed during sleep and walking
about.
 Usually occurs early in the night.
 On awakening, the person has amnesia for
episode

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4. Sleep-Talking:
 Often more annoying to partner than to sleeper.
 Has no memory in morning.
 Can be during REM or delta sleep.
 In REM sleep, pronunciation is clear and
understandable;
 in deep sleep (delta) apt to be mumbled and
unintelligible

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5. Sleep-Related Bruxism
 Bruxism, tooth grinding, occurs throughout the
night, most prominently in stage II sleep.
 5 to 10 percent of the population has sufficient
bruxism to produce noticeable damage to teeth.
 The condition often goes unnoticed by the
sleepers, except for an occasional jaw ache in
the morning, but bed partners and roommates
are consistently awakened by the sound.

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Thank You