GROUP MEMBERS

1.VICTORIA PEDO
2.ABDIRAZAK MOHAMMED
3.GEORGINA NJOROGE

SLEEP-WAKE DISORDERS
They involve problems with the quality of sleep,timing and amount of sleep leading to significant
distress and impairment in social or occupational functioning.

PREVALENCE : These disorders are common, with insomnia being the most prevalent. About
one-third of adults report insomnia symptoms, and 4-22% meet the criteria for insomnia
disorder. Sleep-wake disorders are common in individuals with mental health conditions and the
prevalence is higher among this population compared to the general population.

Consequences of Disturbed Sleep

Disturbed sleep, whether because of quality, timing or duration, can have many adverse health
conse-

quences. The most obvious concerns are fatigue and cognitive focus, but mood can be greatly
affected,

too.

A sleep disorder not only is a risk factor for subsequent development of certain mental
conditions but a

potential warning sign for serious mental or medical issues. For example, sleep disturbances
can signal

the presence of medical and neurological problems such as congestive heart failure,
osteoarthritis, and

Parkinson’s disease.

CLASSIFICATION OF SLEEP DISORDER

> Dyssomnias (quantitative)

Primary insomnia

Primary hypersomnia

• Narcolepsy

Breathing related sleep disorder

Circadian rhythm sleep disorder

• Dyssomnia NOS
• Parasomnias(qualitative)

• Nightmare disorder

Sleep terror disorder

• Sleep walking disorder

• Parasomnia NOS

> Others

• Bruxism

• Restless legs syndrome and periodic limb movement disorder

TYPES:

1.Insomnia Disorder: Persistent difficulty initiating or maintaining sleep, or non-

restorative sleep, causing significant distress or impairment.

TYPES OF INSOMNIA

> ADJUSTMENT INSOMNIA: Associated with anxiety, anticipation of anxiety provoking event
(exam). Transient in nature.

> SLEEP STATE MISPERCEPTION or PSEUDOSOMNIA: patient complaining of difficulty in

sleep but no objective evidence of sleep disruption is found.

> PSYCHOPHYSIOLOGICAL INSOMNIA : problem in going to sleep, stress, object related to

sleep becomes theconditioned to insomnia.

> IDIOPATHIC INSOMNIA: Starts in early life. Neurochemical imbalance of brainstem reticular
formation, impaired regulation of raphe nucleus, locus ceruleus or basal forebrain dysfunction.

2.Hypersomnolence(hypersomnia) Disorder: Excessive daytime sleepiness despite

adequate nighttime sleep, leading to significant impairment in functioning.

3.Sleep-Wake Schedule Disorder: Disruption of the normal sleep-wake schedule, such

as shift work disorder or jet lag disorder.

4.Nightmare Disorder: Recurrent distressing dreams that significantly disrupt sleep.

5.Sleep-related Breathing Disorders: Conditions such as obstructive sleep apnea

characterized by abnormal breathing patterns during sleep.

KLEINE-LEVIN SYNDROME
• This is a rare syndrome characterized by -

1) Hypersomnia (always present)

2) Hyperphagia (usually present)

3) Hypersexuality (associated at times)

• Predominantly afflicts male in adolescence • Recurrent episodes of sleepiness, episode lasting

for few days to several weeks

PROGNOSIS: The prognosis of sleep-wake disorders depends on the underlying cause, the
individual’s overall health, and the effectiveness of treatment. Some conditions may be chronic,
while others can be managed effectively with treatment

ETIOLOGY

1.Biological Factors:

•Neurotransmitter Imbalance: Dysfunction in neurotransmitter systems, such as

serotonin, dopamine, and norepinephrine, can contribute to sleep disturbances seen in
psychiatric disorders.

•Genetic Predisposition: There may be a genetic component to sleep-wake disorders,

with certain genetic variations increasing susceptibility to both psychiatric conditions and sleep
disturbances.

•Neuroendocrine Dysregulation: Imbalances in hormones such as cortisol, melatonin,

and thyroid hormones can disrupt the sleep-wake cycle and contribute to psychiatric symptoms.

2.Psychological Factors:

•Stress and Anxiety: Psychological stressors and anxiety can lead to hyperarousal,
making it difficult to fall asleep or stay asleep.

•Depression: Changes in sleep patterns, including insomnia or hypersomnia, are

common symptoms of depression and can exacerbate existing sleep disturbances.

•Trauma: Individuals with a history of trauma, such as post-traumatic stress disorder

(PTSD), may experience nightmares, flashbacks, and other sleep disturbances.

3.Environmental Factors:

•Lifestyle Habits: Poor sleep hygiene, irregular sleep schedules, excessive caffeine or
alcohol intake, and exposure to electronic devices before bedtime can disrupt the sleep-wake
cycle.

•Social Support: Lack of social support or interpersonal stressors can contribute to sleep
disturbances and exacerbate underlying psychiatric symptoms.
 •Work or School Demands: Shift work, irregular work hours, or academic pressures can
disrupt the circadian rhythm and contribute to sleep-wake disorders.

4.Medication and Substance Use:

•Certain psychiatric medications, such as antidepressants, stimulants, or antipsychotics,

can affect sleep patterns and contribute to sleep disturbances.

•Substance Use: Alcohol, illicit drugs, and some prescription medications can interfere
with sleep architecture and exacerbate psychiatric symptoms.

CLINICAL PRESENTATIONS

Here are some common clinical presentations:

1.Insomnia Disorder:

•Difficulty falling asleep (sleep onset insomnia)

•Difficulty maintaining sleep, with frequent awakenings throughout the night (sleep
maintenance insomnia)

•Early morning awakening with an inability to return to sleep

•Daytime fatigue, irritability, and impaired concentration due to poor sleep quality

•Heightened anxiety or rumination about sleep, leading to increased arousal and

exacerbation of insomnia symptoms

2.Hypersomnolence Disorder:

•Excessive daytime sleepiness, regardless of the amount of nighttime sleep

•Difficulty staying awake during the day, even in stimulating or engaging situations

•Prolonged naps or episodes of unintentional sleep during the day

•Impaired concentration, memory, and cognitive function due to excessive sleepiness

•Functional impairment in daily activities, including work, school, or social interactions,

due to sleepiness

3.Sleep-Wake Schedule Disorder:

•Irregular sleep-wake patterns, such as frequent changes in sleep timing or difficulty

adjusting to shift work schedules

•Difficulty falling asleep at the desired bedtime (delayed sleep phase) or difficulty waking
up at the desired time (advanced sleep phase)

•Daytime fatigue, irritability, and impaired performance due to mismatch between sleep-
wake schedule and social or work demands
 •Distress or impairment related to the inability to maintain a consistent sleep-wake
schedule

4.Nightmare Disorder:

•Recurrent distressing dreams or nightmares, often involving themes of threat, danger,

or helplessness

•Intense fear or anxiety upon awakening from nightmares, leading to difficulty falling
back asleep

•Avoidance of sleep or reluctance to go to bed due to fear of experiencing nightmares

•Daytime fatigue, irritability, and impaired functioning due to disrupted sleep and
emotional distress related to nightmares

5.Sleep-related Breathing Disorders:

•Loud or disruptive snoring during sleep, often reported by bed partners

•Breathing interruptions during sleep, such as pauses in breathing followed by gasping

or choking sounds (indicative of sleep apnea)

•Excessive daytime sleepiness, fatigue, and impaired cognitive function due to

fragmented sleep and oxygen desaturation

•Morning headaches, dry mouth, or sore throat upon awakening (common symptoms of
sleep-disordered breathing)

DIAGNOSTIC CRITERIA
According to DSM-5:
1.Insomnia disorder

● Challenges falling asleep (onset insomnia): inability to fall asleep beyond 20-30 minutes.
● Inability to maintain sleep (middle insomnia): frequent waking during the night after sleep
onset beyond 20-30 minutes, and difficulty returning to sleep after mid-night waking.
● Early-morning wakefulness (late insomnia): waking at least 30 minutes before the
desired time and before sleep reaches 6.5 hours (often accompanied by an inability to
resume sleep at all).
○ Other necessary criteria:
○ Sleep difficulty is present at least 3 nights per week and for a period of at least 3
months.
○ You’re unable to sleep even with ample opportunity.
● Comprehensive assessment, including patient history, physical exams, questionnaires,
and clinical testing, is essential for diagnosis.

2.Hypersomnolence Disorder (DSM-5):

 •Self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours,
with one or both of the following:

•Recurrent periods of sleep or lapses into sleep within the same day (e.g., naps).

•A prolonged main sleep episode of more than 9 hours per day, which is non-restorative
or unrefreshing.

•The excessive sleepiness occurs at least three times per week for at least three
months.

•The excessive sleepiness causes significant distress or impairment in social,

occupational, or other important areas of functioning.

•The excessive sleepiness is not better explained by another sleep disorder, medical or
mental health condition, or the effects of substance use.

3.Nightmare Disorder (DSM-5):

•Recurrent episodes of extended, extremely dysphoric, and well-remembered dreams

that usually involve threats to survival, security, or physical integrity.

•Upon awakening from the nightmare, the individual rapidly becomes oriented and alert.

•The nightmares cause significant distress or impairment in social, occupational, or other

important areas of functioning.

•The nightmares occur at least once per week.

•The nightmares are not attributable to the physiological effects of a substance or

another medical condition.

4.Sleep-related Breathing Disorders (DSM-5):

•The presence of symptoms of disturbed sleep, such as loud snoring, breathing

interruptions, or excessive daytime sleepiness.

•Polysomnography (sleep study) findings confirming the presence of sleep-related

breathing disturbances, such as obstructive sleep apnea or central sleep apnea.

•The sleep-related breathing disturbances cause significant distress or impairment in

social, occupational, or other important areas of functioning.

•The sleep-related breathing disturbances are not better explained by another sleep
disorder, medical or mental health condition, or the effects of substance use.

MANAGEMENT

1.Biomedical Interventions:

•Medications: Pharmacotherapy may be prescribed to address specific symptoms or

underlying conditions contributing to sleep disturbances. This may include sedative-hypnotics
for insomnia, antidepressants for depression with sleep disturbances, or medications to manage
underlying medical conditions like sleep apnea.

•Continuous Positive Airway Pressure (CPAP): For sleep-related breathing disorders

such as obstructive sleep apnea, CPAP therapy is often the first-line treatment to improve
breathing and alleviate symptoms.

2.Psychological Interventions:

•Cognitive-Behavioral Therapy for Insomnia (CBT-I): CBT-I is an evidence-based

approach that targets maladaptive thoughts and behaviors related to sleep. It helps individuals
develop healthier sleep habits, regulate their sleep-wake cycle, and manage stress or anxiety
associated with sleep.

•Stress Management Techniques: Techniques such as relaxation exercises, mindfulness

meditation, and biofeedback can help reduce arousal and promote relaxation before bedtime.

3.Social Interventions:

•Sleep Hygiene Education: Providing education on good sleep hygiene practices, such
as maintaining a regular sleep schedule, creating a comfortable sleep environment, and
avoiding stimulants like caffeine or electronic devices before bedtime.

•Supportive Relationships: Encouraging the involvement of supportive family members

or friends in the patient’s treatment plan can provide emotional support and help create a
conducive environment for sleep.

4.Spiritual Interventions:

•Mindfulness Practices: Encouraging mindfulness-based practices, such as meditation or

yoga, can help individuals cultivate awareness and acceptance of their sleep experiences.
Spiritual counseling or support groups may also provide comfort and guidance in coping with
sleep disturbances.

Nursing Care:

1.Assessment:

•Conduct a comprehensive assessment of the patient’s sleep patterns, including

duration, quality, and any associated symptoms or behaviors.

•Assess for underlying mental health conditions, medical comorbidities, and

psychosocial stressors that may contribute to sleep disturbances.

2.Education:

•Provide patient and family education on the importance of sleep hygiene and the role of
lifestyle factors in promoting healthy sleep habits.

•Educate patients about the effects of medications or substances on sleep and the
importance of medication adherence.
 3.Support:

•Offer emotional support and validation of the patient’s sleep-related concerns and
struggles.

•Provide counseling and encouragement to address any fears or anxieties related to

sleep disturbances.

4.Collaboration:

•Collaborate with other healthcare professionals, including psychiatrists, psychologists,

and sleep specialists, to develop an integrated treatment plan.

•Coordinate care transitions and follow-up appointments to monitor treatment progress and
adjust interventions as needed.

5.SLEEP HYGIENE EDUCATION

• Maintain regular hours of bedtime and arising

• Avoid heavy meals near bedtime

• Avoid daytime napping

• Exercise daily, but not later in the evening

• Minimize caffeine intake and smoking within 8 hr of bedtime

• Do not look at clock in night

• Make bedroom comfortable, preferably slightly cool

• Do not use alcohol while going to sleep

• Go to bed only when sleepy

• Minimize light, noise and excessive temperature during sleep • Avoid evening stimulation:
substituted radio or relaxed reading for television. Practice evening relaxation routines

NURSING DIAGNOSIS

1.Disturbed Sleep Pattern:

Related Factors:

○ Dysfunction of the environment or physiologic factors.

○ Secondary to insomnia or other sleep-wake disorders.
○ Evidence:
○ Decreased quality of sleep.
○ Disturbed sleep patterns.
 ○ Daytime sleepiness.
○ Difficulty falling asleep.

2.Anxiety:

•Related to fear of sleep disturbances, nightmares, or the consequences of inadequate

sleep on mental health and functioning.

•Related to stressors contributing to sleep disturbances, such as work or relationship

problems, financial stress, or health concerns.

3.Impaired Coping:

•Related to chronic sleep disruption and its impact on emotional regulation, cognitive
function, and daily functioning.

•Related to inadequate coping skills or maladaptive coping strategies used to manage

sleep-related stressors.

4.Fatigue:

•Related to inadequate or poor-quality sleep, as evidenced by reports of excessive

daytime sleepiness, lethargy, or decreased energy levels.

•Related to the presence of a mental health condition, such as depression or bipolar

disorder, which can contribute to fatigue and sleep disturbances.

5.Risk for Injury:

•Related to sleepwalking, sleep-related behaviors, or impaired judgment due to sleep

deprivation.

•Related to environmental hazards in the healthcare setting, such as falls or accidents

during nighttime hours.

6.Disturbed Thought Processes:

•Related to cognitive impairment or disorientation due to sleep deprivation or fragmented

sleep.

•Related to the presence of delusions or hallucinations exacerbated by sleep

disturbances or sleep deprivation.

7.Social Isolation:

•Related to daytime sleepiness or fatigue, leading to decreased participation in social

activities or withdrawal from social interactions.

•Related to stigma or shame associated with sleep-wake disorders, leading to avoidance

of social situations or reluctance to seek support.