Sleep Disorders Overview
1. Normal Sleep Physiology
– Sleep Cycles: Sleep consists of repeated 90-minute cycles of non-REM (NREM) and REM (rapid eye movement) sleep.
NREM Stages:
– N1: Light sleep (5% of sleep). Transition from wakefulness, often includes hypnic jerks. EEG shows alpha to theta waves.
– N2: Moderate sleep (50%). Sleep spindles appear on EEG.
– N3 & N4: Deep sleep (20%). Characterized by delta waves. Muscle paralysis occurs, making waking difficult. Shortens with age.
REM Sleep:
– Makes up 25% of sleep.
– Muscles are paralyzed (except the diaphragm), dreams occur, and there are changes in heart rate and blood pressure.
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2. Common Sleep Disorders
– Insomnia: Difficulty falling or staying asleep, leading to distress.
– Prevalence: Affects about 1/3 of the population, more common in women.
– Management:
– Sleep Hygiene: Avoid caffeine and alcohol, maintain regular sleep schedule, exercise regularly.
– Sleep Apnea:
– Obstructive Sleep Apnea (OSA): Blockage of the airway during sleep.
– Central Sleep Apnea: No obstruction; caused by a lack of respiratory effort.
– Causes: Conditions like heart failure, neuromuscular diseases, and brainstem lesions.
– Presentation: Daytime sleepiness, morning headaches, and episodes of apnea, worse during REM sleep.
– Narcolepsy:
– Pathophysiology: Loss of neurons that produce hypocretin (orexin).
– Symptoms: Excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), hallucinations, sleep paralysis.
– Diagnosis: Clinical observation and polysomnography.
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– Parasomnias: Abnormal behaviors during sleep.
– NREM Parasomnias: Includes sleepwalking and night terrors, often occurring during deep sleep.
– REM Behavior Disorder: Loss of muscle paralysis during REM, leading to acting out dreams; associated with Parkinson’s disease.
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3. Key Terms to Know
– Hypnic Jerks: Sudden muscle contractions occurring as a person falls asleep.
– Sleep Hygiene: Practices that promote good sleep quality.
– Cataplexy: Sudden loss of muscle tone triggered by strong emotions.
– Polysomnography: A sleep study that records brain activity, oxygen levels, heart rate, and breathing.
Summary
Understanding sleep disorders involves recognizing normal sleep patterns, identifying common disorders, and knowing how to manage them effectively. This knowledge is essential for nursing students to provide holistic care to patients experiencing sleep issues.
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