1. Chapter 19: Sleep Disorders: Dyssomnias and Parasomnias Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. 2 Sleep  Basic human need  Fundamental for survival  47 to 70 million Americans suffer from some type of sleep disorder

3. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Some Causes of Sleep Deprivation  Insomnia  Narcolepsy  Breathing-related sleep disorders  Circadian rhythm sleep disturbances  Recurrent nightmares  Sleep terrors  Sleepwalking

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Figure 18-1 The electroencephalogram (EEG). A, Photograph showing a person undergoing an EEG test. Notice the scalp electrodes that detect voltage fluctuations within the cranium. B, Examples of alpha, beta, theta, and delta waves seen on an EEG. (From Lewis SM: Medical- surgical nursing: assessment and management of clinical problems, ed 7, St Louis, 2007, Elsevier.)

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Figure 18-2 Normal sleep cycles. Rapid eye movement (REM) sleep occurs cyclically throughout the night at intervals of approximately 90 minutes in all age-groups. REM sleep shows little variation in the different age-groups, whereas stage 4 sleep decreases with age. In addition, elderly persons awake frequently and show a marked increase in total time awake. (From McCance KL, Huether SE: Pathophysiology: the biologic basis for disease in adults and children, ed 5, St Louis, 2006, Elsevier.)

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sleep Disorders  Primary  Dyssomnias  Parasomnias  Secondary  Related to psychiatric illness, effect of substances, or secondary to a general medical condition

7. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Etiology  Biologic  Genetic, hereditary, and familial factors  Psychiatric, cognitive, and behavioral factors  Direct physiologic effects of a general medical condition  Sociocultural and environmental factors

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Dyssomnias  Insomnia  Narcolepsy, hypersomnias  Breathing-related sleep disorders  Circadian rhythm sleep disturbance

9. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Insomnia  Most common sleep disorder  Estimated 30 million adults are affected  More common in women  Link between insomnia and psychiatric illness (depression)

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Narcolepsy  Excessive daytime sleepiness  Between 135,000 and 250,000 people affected  Not common in children; generally initially recognized during adolescence

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Breathing-Related Sleep Disorder  Sleep apnea  Affects 18 million Americans  More common in men ages 30 to 60  Prevalence:  4% adult male population  2% adult female population  1% to 3% of children, usually the result of adenotonsillar hypertrophy, craniofacial abnormalities, or allergic conditions

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Parasomnias  Nightmares  Sleep terror disorder  Sleepwalking disorder  Parasomnia not otherwise specified

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sleep Terror Disorder  Occurs in 1% to 6% of children  Typically ages 3 to 8  More common in boys  Tends to run in families

14. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nightmares  Any age, any gender  Child able to recall event (not typical with sleep terrors)

15. 15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sleepwalking Disorder  Occurs ages 4 to 8, with peak prevalence at 12 years of age  More common in boys  Tends to run in families