Geriatric Department

Sleep
problems

Prepared by : group 4

Under super vision of :

Dr. Amany Mhmoud Dr.

Eman Salah
‫شارك ف االعداد‪:‬‬
Outline
1. introduction and definition of sleep and
sleep disorder .

2. normal sleep time and function of sleep .

3. the stage of sleep .

4. difference between REM and NREM Narcolepsy

sleep .
17. definition .
5. aging change and sleep .
18. symptoms
6. causes and risk factor of sleep disorder .
19. causes
7. S&S of sleep disorder .
PLMD
Insomnia
20. Definition . 21.
8. definition and type of insomnia .
symptoms .
9. causes .
22. causes .
10. symptoms .
Sleep apnea
Restlessness
23. definition.
11. definition .
24. symptoms .
12. causes .
25. causes .
13. symptoms .
Sleep paralysis
RLS
26. definition.
14. Introduction ( definition / type
27. symptoms .
/incidence ) .
28. causes .
15. symptoms .
29. sleep disorder complication .
16. causes .
30. obesity hypoventilation syndrome .

31. sleep related hypoxemia .

32. Gerontological nursing role for

sleep disorders
Introduction To Sleep And Sleep Disorders
Sleep is a fundamental biological process essential for overall health and well-
being. It is a complex state of rest during which the body and mind undergo
critical restorative functions, including memory consolidation, tissue repair,
and hormonal regulation. Sleep is divided into different stages, including non-
rapid eye movement (NREM) and rapid eye movement (REM) sleep, which
cycle throughout the night to support physical and mental health.

Definition Of Sleep Disorders :

Sleep disorders are conditions that disrupt the normal sleep pattern, affecting the ability to fall asleep, stay
asleep, or achieve restful sleep. These disorders can lead to excessive daytime sleepiness, impaired cognitive
function, mood disturbances, and long-term health complications. Sleep disorders can be caused by various
factors, including genetics, lifestyle habits, medical conditions, and environmental influences.

Some Common Types Of Sleep Disorders Include:

1. Insomnia – Difficulty falling or staying asleep.

2. Sleep Apnea – Interrupted breathing during sleep due to airway obstruction or brain-related issues.

3. Narcolepsy – Sudden and uncontrollable episodes of sleep during the day.

4. Restless Legs Syndrome (RLS) – Uncomfortable sensations in the legs that cause an urge to move,
disrupting sleep.

5. Circadian Rhythm Disorders – Disruptions in the body's internal clock, leading to sleep-wake cycle
disturbances.

Proper diagnosis and management of sleep disorders are crucial for maintaining overall health, as
poor sleep is linked to various chronic conditions such as heart disease, diabetes, and mental health
disorders. Treatments range from lifestyle modifications and behavioral therapy to medications and
medical interventions, depending on the underlying cause.

Normal Sleep Time

Sleep is essential for overall health and well-being. The required sleep duration varies based on age and
individual needs.

Recommended Sleep Duration by Age

• Newborns (0-3 months): 14-17 hours

• Infants (4-11 months): 12-16 hours (including naps)

• Toddlers (1-2 years): 11-14 hours

• Preschoolers (3-5 years): 10-13 hours

• School-age children (6-13 years): 9-11 hours

• Teenagers (14-17 years): 8-10 hours

 • Young adults (18-25 years): 7-9 hours

• Adults (26-64 years): 7-9 hours

• Older adults (65+ years): 7-8 hours

Stages
Sleep can be divided into 2 phases — non-rapid eye movement (NREM) and rapid eye movement
(REM) — and 4 stages that make a complete cycle. You’ll typically complete 4 to 6 cycles Trusted
Source per night.

The first 3 stages, part of the first phase, are called non-REM sleep (N1 through N3). The final stage
and second phase is REM.

NREM stage N1

Stage N1 is the transition from wakefulness to sleep.

It generally lasts only a few minutes and is the lightest stage of sleep. If you’re awoken from N1, you usually
don’t perceive that you were actually asleep.

In this stage Trusted Source:

• eye movements are typically slow and rolling

• heartbeat and breathing slow

• muscles begin to relax

• brain waves begin to slow

NREM stage N2

Stage N2 comprises the largest percentage of total sleep time. It’s a lighter stage of sleep from which you
can still be awoken easily. This is the stage before you enter deep sleep.

• You may also experience Trusted Source:

• slower heartbeat and breathing

• no eye movements

• a drop in body temperature

• slower brain waves but still showing brief bursts of activity

NREM stage N3

The final stage of non-REM sleep, N3, is the deepest sleep stage. Your body performs various
healthpromoting functions in this stage.

You may also experience Trusted Source:

• difficulty being awoken

• even slower heartbeat and breathing

• no eye movements
 • a fully relaxed body

• slower brain waves, indicating healing and restorative sleep

• tissue repair and growth

• cell regeneration

• your immune system strengthen

REM stage R

Stage R occurs about 90 minutes after Trusted Source you fall asleep. This stage lasts roughly 10 minutes the
first time and increases with each REM cycle. Stage R’s final cycle may last roughly 30 to 60 minutes.

Stage R is typically when you dream. You may likely experience:

• rapid eye movements behind your closed eyelids

• faster and more variable breathing

• increased blood pressure and heart rate

• muscle paralysis, but twitches may occur

• brain activity similar to that of being awake

You cycle through all of these stages of sleep 4 to 6 times — roughly every 90 minutes — when you fall
asleep.

Difference Between REM and NREM Sleep

Sleep is divided into two main types: REM (Rapid Eye Movement) sleep and NREM (Non-Rapid Eye
Movement) sleep. These two phases serve different functions and have distinct characteristics.

1. REM Sleep (Rapid Eye Movement Sleep) *Brain Activity* : High, similar

to when awake.

*Eye Movement* : Rapid and irregular.

*Muscle Activity* : Almost no muscle movement (temporary paralysis).

*Dreaming* : Vivid and intense dreams occur.

Heart Rate & Breathing: Irregular and fast.

*Role in Sleep* : Helps with memory consolidation, learning, and emotional processing.

*Time in Sleep Cycle* : Usually starts about 90 minutes after falling asleep and lasts longer in later sleep
cycles.

2. NREM Sleep (Non-Rapid Eye Movement Sleep)

*Brain Activity* : Slow and synchronized, preparing for deep rest.

*Eye Movement* : No or slow eye movement.

*Muscle Activity* : Some muscle movement and tone.

*Dreaming* : Less frequent and less vivid than in REM sleep.

*Heart Rate & Breathing* : Slow and steady.

*Role in Sleep* : Supports physical recovery, immune function, and deep rest.

*Time in Sleep Cycle* : Makes up about 75-80% of total sleep

Aging is a natural process that brings about various changes in the body, including those that affect
sleep. As people age, they often experience alterations in their sleep patterns and quality.

Here are some key ways in which aging can impact sleep:

1. **Changes in Sleep Architecture**:

- **Reduced Deep Sleep (Slow-Wave Sleep)**: Older adults tend to spend less time in deep sleep,
which is the most restorative stage of sleep. This can lead to feeling less rested upon waking.

- **Increased Light Sleep**: There is a shift towards lighter stages of sleep, making it easier to be
awakened by disturbances.

2. **Altered Circadian Rhythms**:

- **Advanced Sleep Phase**: Many older adults experience a shift in their internal clock, leading to earlier
bedtimes and wake times. This is known as advanced sleep phase syndrome.

- **Reduced Melatonin Production**: The production of melatonin, the hormone that regulates sleep-

3. **Increased Sleep Fragmentation**:

- **Frequent Awakenings**: Older adults often experience more frequent awakenings during the
night, which can disrupt the continuity of sleep.

- **Difficulty Falling Back Asleep**: After waking up, it may take longer to fall back asleep, leading
to reduced total sleep time.

4. **Higher Prevalence of Sleep Disorders**:

- **Insomnia**: Difficulty falling or staying asleep becomes more common with age.

- **Sleep Apnea**: The risk of sleep apnea, a condition characterized by pauses in breathing during sleep,
increases with age.

- **Restless Legs Syndrome (RLS)**: This condition, which causes an irresistible urge to move the legs,
often worsens with age.

5. **Health Conditions and Medications**:

- **Chronic Illnesses**: Conditions such as arthritis, heart disease, and diabetes can interfere with sleep.

- **Medications**: Many medications taken by older adults can have side effects that impact sleep, either
by causing drowsiness or by disrupting sleep patterns.

6. **Lifestyle Factors**:
- **Reduced Physical Activity**: Lower levels of physical activity can contribute to poorer sleep quality.

- **Social Isolation**: Loneliness and social isolation, which are more common in older adults, can
negatively affect sleep

Sleep disorders can be caused by a variety of factors, including medical conditions, lifestyle choices,
and psychological factors.

Here are some common causes:

1. Medical Conditions

• Chronic pain (e.g., arthritis, fibromyalgia)

• Respiratory issues (e.g., asthma, sleep apnea)

• Neurological disorders (e.g., Parkinson’s disease, Alzheimer's)

• Hormonal imbalances (e.g., thyroid problems)

• Gastro esophageal reflux disease (GERD)

2. Psychological Factors

• Stress and anxiety

• Depression

• Post-traumatic stress disorder (PTSD)

• Bipolar disorder
3. Lifestyle and Behavioral Factors

• Poor sleep hygiene (irregular sleep schedule, using screens before bed)

• Excessive caffeine, nicotine, or alcohol consumption

• Shift work or jet lag

• Lack of physical activity

4. Genetic and Neurological Causes

• Family history of sleep disorders (e.g., narcolepsy)

• Brain chemistry imbalances affecting sleep regulation

5. Environmental Factors

• Noisy or uncomfortable sleeping conditions

• Exposure to blue light from screens before bed

• Temperature extremes
6. Medications and Substance Use
Side effects of medications (e.g., antidepressants, stimulants, corticosteroids)

General Signs & Symptoms:

• Difficulty falling or staying asleep (insomnia)

• Excessive daytime sleepiness (hypersomnia)

• Loud snoring or gasping for air during sleep (sleep apnea)

• Uncontrollable urge to move legs at night (restless legs syndrome)

• Frequent nightmares or sleepwalking (parasomnias)

• Waking up too early and not being able to go back to sleep

• Difficulty concentrating or memory problems due to poor sleep Insomnia

is a sleep disorder characterized by difficulty falling asleep, staying asleep, or

waking up too early and not being able to go back to sleep. It can lead to daytime
fatigue, irritability, difficulty concentrating, and other health issues. Insomnia can be
short-term (acute) or long-term (chronic) and may be caused by stress, anxiety,
medical conditions, poor sleep habits, or certain medications

Types Of Insomnia

There are several types of insomnia, categorized based on duration, cause, and nature of the sleep
disturbance. The main types include:

1. Acute Insomnia – Short-term insomnia that lasts for a few days or weeks, often triggered by stress,
life changes, or a temporary disruption in sleep patterns.

2. Chronic Insomnia – Long-term insomnia that occurs at least three times a week for three months or
longer, often linked to underlying medical conditions, mental health issues, or lifestyle factors.

3. Onset Insomnia – Difficulty falling asleep at the beginning of the night, often caused by anxiety,
stress, or caffeine consumption.

4. Maintenance Insomnia – Difficulty staying asleep, with frequent awakenings or trouble going back
to sleep, often associated with depression, chronic pain, or other medical conditions.

5. Early Morning Awakening Insomnia – Waking up too early and being unable to fall back asleep,
sometimes linked to depression or aging.

6. Comorbid Insomnia (or Secondary Insomnia) – Insomnia that occurs alongside other medical or
psychological conditions, such as chronic pain, asthma, anxiety, or depression.

7. Behavioral Insomnia of Childhood (BIC) – Insomnia in children due to poor sleep habits, resistance
to bedtime, or dependence on certain conditions to fall asleep (e.g., needing a parent present).

Insomnia can be caused by a variety of factors, including:

1. Psychological Factors
 • Stress, anxiety, or depression

• Overthinking or excessive worrying

• Post-traumatic stress disorder (PTSD)

2. Lifestyle and Behavioral Factors

• Irregular sleep schedule

• Excessive screen time before bed

• Consuming caffeine, nicotine, or alcohol close to bedtime

• Lack of physical activity

3. Medical Conditions

• Chronic pain (arthritis, back pain, migraines)

• Respiratory problems (asthma, sleep apnea)

• Neurological disorders (Parkinson’s, Alzheimer’s)

• Acid reflux or gastrointestinal issues

4. Medications and Substances

• Certain antidepressants, blood pressure medications, and corticosteroids

• Stimulants (e.g., those for ADHD or asthma)

• Withdrawal from sleeping pills or drugs

5. Environmental Factors

• Noise, light, or an uncomfortable sleep environment

• Extreme temperatures in the bedroom

6. Hormonal Changes

• Menopause or pregnancy-related changes

• Thyroid imbalances

7. Poor Sleep Habits

• Napping too much during the day

• Sleeping at inconsistent times

The symptoms of insomnia include:

1. Difficulty falling asleep despite feeling tired.

2. Waking up frequently during the night.

3. Trouble staying asleep or waking up too early and not being able to go back to sleep.

4. Feeling tired or unrefreshed upon waking.

5. Daytime sleepiness, fatigue, or low energy.

6. Irritability, mood changes, or difficulty controlling emotions.

7. Difficulty concentrating or remembering things.

8. Increased errors or accidents due to lack of sleep.

9. Anxiety about sleep or frustration over sleep difficulties. Restlessness

is a state of being unable to stay still, calm, or satisfied. It is

often characterized by constant movement, agitation, or an
overwhelming urge to do something. Restlessness can be caused
by various factors, including anxiety, boredom, stress,
excitement, or physical discomfort. It can manifest physically
(such as fidgeting, pacing, or an inability to sit still) or mentally
(such as racing thoughts, impatience, or difficulty focusing).

Restlessness can be caused by a variety of factors, both physical and psychological .

Some of the most common causes include:

1. Stress :

Feeling overwhelmed by work, personal relationships, or financial concerns can lead to a constant feeling of
restlessness.

2. Sleep Disorders:

Conditions like insomnia, sleep apnea, or restless leg syndrome can lead to disrupted or poor-quality sleep,
causing daytime restlessness.

3. Caffeine or Stimulants:

Consuming too much caffeine, nicotine, or other stimulants can cause jitteriness and restlessness, especially
if consumed later in the day.

4. Medications:

Certain medications, such as antidepressants, steroids, or stimulants (used to treat ADHD), can have side
effects that cause restlessness.

5. Mental Health Disorders:

Conditions such as depression, bipolar disorder, and obsessive-compulsive disorder (OCD) may present with
restlessness as a symptom.

6. Hormonal Imbalances:

Changes in hormone levels (e.g., thyroid imbalances, menopause, or pregnancy) can lead to feelings of
restlessness or nervous energy.

7. Nutritional Deficiencies:
Deficiencies in vitamins and minerals (like magnesium, B vitamins, or iron) can lead to physical symptoms
of restlessness.

8. Physical Health Conditions:

Medical conditions such as hyperthyroidism, diabetes, or heart disease can cause restlessness as a result of
the body's increased physical demands.

9. Boredom or Lack of Purpose:

When people don't feel mentally engaged or purposeful, they may experience restlessness, wanting
something to do but unsure of what that is.

10. Withdrawal from Substances:

If someone is withdrawing from drugs, alcohol, or other substances, they might experience restlessness as
part of the withdrawal symptoms.

11. Environmental Factors:

A noisy, chaotic, or uncomfortable environment can contribute to feelings of restlessness. This could include
crowded places, loud sounds, or an overly cluttered living space.

Restlessness can manifest in both physical and psychological ways.

Here are some common symptoms:

1. Physical Symptoms

• Inability to stay still (constant movement, pacing, fidgeting)

• Tense or jittery feeling (muscle tension, shaking, tapping feet or hands)

• Rapid heartbeat or breathing

• Sweating (especially in stressful situations)

• Difficulty relaxing, even when tired

• Uncomfortable urge to move, especially at night (common in restless legs syndrome)

2. Psychological Symptoms

• Feeling on edge or unsettled

• Racing thoughts (inability to focus or constant worry)

• Irritability or impatience

• Difficulty concentrating

• Anxiety or nervousness
3. Sleep-Related Symptoms

• Tossing and turning in bed

 • Frequent awakenings at night

• Feeling exhausted but unable to sleep

Restless Legs Syndrome (RLS)

is a neurological condition that causes an uncontrollable
urge to move the legs, usually due to uncomfortable
sensations like tingling, crawling, or throbbing. Symptoms
typically worsen during periods of rest or inactivity,
especially at night, leading to sleep disturbances.

Types of RLS

1. Based on Cause:

Primary RLS:

• Has no known cause and is often hereditary.

• Usually develops before age 40 and can persist for life.

• Symptoms start mild or intermittent but may worsen over time.

Secondary RLS:

Caused by an underlying medical condition or deficiency, such as:

• Iron deficiency

• Kidney failure

• Diabetes

• Pregnancy (especially in the third trimester)

• Certain medications (e.g., antidepressants, antihistamines)

Restless Legs Syndrome (RLS) is a neurological condition that causes uncomfortable sensations in the
legs and an overwhelming urge to move them. Symptoms typically occur while at rest or lying down,
especially at night, making it difficult to sleep.

Symptoms:

1. Uncomfortable sensations in the legs: These may feel like itching, crawling, or throbbing.

2. An irresistible urge to move the legs to relieve the discomfort.

3. Worsening of symptoms at night or when lying down: Symptoms tend to worsen during relaxation or
before sleep.

4. Relief with movement: Walking or moving the legs can alleviate the discomfort.

5. Return of discomfort when movement stops: The uncomfortable sensations return when the legs are still.
Causes:

1. Genetic factors: RLS may run in families in some cases.

2. Iron deficiency: Low iron levels in the blood can contribute to symptoms.

3. Other medical conditions: Conditions like diabetes, kidney failure, and nerve disorders can increase the
risk.

4. Pregnancy: Some women experience RLS during pregnancy, particularly in the third trimester.

5. Medication side effects: Certain medications, like antidepressants or anti-nausea drugs, can worsen
symptoms.

6. Sleep disorders: Conditions like sleep apnea may increase RLS symptoms.

Narcolepsy
is a condition that makes people very sleepy during the day and can cause them
to fall asleep suddenly.

Some people also have other symptoms, such as :

• muscle weakness when they feel strong emotions.

• Changes in rapid eye movement (REM) sleep. REM sleep is when most
dreaming happens. Typically, people enter REM sleep 60 to 90 minutes after falling asleep. But
people with narcolepsy often move more quickly to REM sleep. They tend to enter REM sleep
within 15 minutes of falling asleep. REM sleep also can happen at any time of the day.

• Other sleep symptoms

People with narcolepsy may have other sleep conditions. They might have obstructive sleep apnea, in which
breathing starts and stops during the night. Or they may act out their dreams, known as REM sleep behavior
disorder. Or they may have trouble falling asleep or staying asleep, called insomnia.

Causes

• The exact cause of narcolepsy is not known. People with type 1 narcolepsy have low levels of
hypocretin (hi-poe-KREE-tin), also called orexin. Hypocretin is a chemical in the brain that helps
control being awake and entering REM sleep.

• Hypocretin levels are low in people who have cataplexy. Exactly what causes the loss of
hypocretinproducing cells in the brain isn't known. But experts suspect it's due to an autoimmune
reaction. An autoimmune reaction is when the body's immune system destroys its own cells.

• It's also likely that genetics plays a role in narcolepsy. But the risk of a parent passing this sleep
condition to a child is very low — only about 1% to 2%.

• Narcolepsy may be linked to exposure to the H1N1 flu, sometimes called the swine flu. It also may
be linked to a certain type of the H1N1 vaccine that was given in Europe.
Typical sleep pattern vs. narcolepsy

The typical process of falling asleep begins with a phase called non-rapid eye movement (NREM) sleep.
During this phase, brain waves slow. After an hour or so of NREM sleep, brain activity changes and REM
sleep begins. Most dreaming occurs during REM sleep.

In narcolepsy, you may suddenly enter REM sleep after going through minimal NREM sleep. This can
happen both at night and during the day. Cataplexy, sleep paralysis and hallucinations are similar to changes
that occur in REM sleep. But in narcolepsy, these symptoms happen while you're awake or sleepy.

Risk factors

There are only a few known risk factors for narcolepsy, including:

• Age. Narcolepsy typically begins between ages 10 and 30.

• Family history. Your risk of narcolepsy is 20 to 40 times higher if you have a close family member
who has it.

Periodic limb movement disorder (PLMD)

is a sleep disorder where the patient moves limbs involuntarily and

periodically during sleep, and has symptoms or problems related to
the movement. PLMD should not be confused with restless legs
syndrome (RLS), which is characterized by a voluntary response to
an urge to move legs due to discomfort. PLMD on the other hand is
involuntary, and the patient is often unaware of these movements
altogether. Periodic limb movements (PLMs) occurring during
daytime period can be found but are considered as a symptom of
RLS; only PLMs during sleep can suggest a diagnosis of PLMD

It is mostly unknown what causes PLMD, but in many cases the patient also has other medical problems
such as Parkinson's disease or narcolepsy. Medical agents must be taken into consideration: several
psychopharmacological drugs (serotonergic and tricyclic antidepressants, venlafaxine and mirtazapine)
heighten the risk of PLMD.[4] For women, the presence of musculoskeletal disease, heart disease,
obstructive sleep apnea, cataplexy, doing physical activities close to bedtime and the presence of a mental
disorder were significantly associated with having a higher risk of both PLMD and restless legs syndrome

PLMS seems to have an origin in the spinal cordIn fact, PLMS was suggested to be associated with
increased spinal reflexes. Manifestations of PLMS seem to occur mostly in disorders associated with
dopaminergic dysfunctions

Hypothesis of low ferritin levels in adult population was raised to explain PLMD where increased RLS
severity and increased PLMS were significantly correlated with low ferritin levels. Research evidence
suggested iron is possibly contributing to PLMD. Thus, lack of iron may induce inhibition of dopamine
formation which might underlie PLMS.

People with PLMD often have excessive daytime sleepiness (EDS), falling asleep during the day, trouble
falling asleep at night, and difficulty staying asleep throughout the night. Patients also display involuntary
limb movements that occur at periodic intervals anywhere from 20 to 40 seconds apart. They often only last
the first half of the night during non-REM sleep stages. Movements do not occur during REM because of
muscle atonia.
PLMS can be unilateral or bilateral and not really symmetrical or simultaneous .PLMS is often a
symptom of RLS but evidence for differences between those two sleep disorders was found in literature.
Sleep structure differed, when RLS patients had significantly more REM sleep and less stage 1 sleep
compared to PLMD patients. Besides, PLMI was significantly higher in patients with PLMD

Sleep Apnea
(sleep apnea or sleep apnea in British English) is a sleep-related
breathing disorder in which repetitive pauses in breathing, periods
of shallow breathing, or collapse of the upper airway during sleep
results in poor ventilation and sleep disruption. pause in breathing
can last for a few seconds to a few minutes and often occurs many
times a night .A choking or snorting sound may occur as breathing
resumes Common symptoms include daytime sleepiness, snoring,
and non-restorative sleep despite adequate sleep time. Because the
disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It
is often a chronic condition.

Sleep apnea (sleep apnea or sleep apnea in British English) is a sleep-related breathing disorder in which
repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep
results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few
minutes and often occurs many times a night. A choking or snorting sound may occur as breathing resumes.
Common symptoms include daytime sleepiness, snoring, and non-restorative sleep despite adequate sleep
time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired
during the day. It is often a chronic condition.

Causes of sleep apnea

Sleep apnea happens if your airways become too narrow while you sleep. This stops you breathing properly.

Sleep apnea has been linked to:

• obesity

• having a large neck

• getting older – although children and young adults can also get it

• having other family members with sleep apnea

• smoking and drinking alcohol

• having large tonsils or adenoids

• sleeping on your back

• a condition called chronic obstructive pulmonary disease (COPD)

The main types of sleep apnea are:

• Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles
relax and block the flow of air into the lungs
 • Central sleep apnea (CSA), which occurs when the brain doesn't send proper signals to the muscles
that control breathing

• Treatment-emergent central sleep apnea, also known as complex sleep apnea, which happens when
someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy
for OSA

Symptoms

The symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine
which type you have. The most common symptoms of obstructive and central sleep apneas include:

• Loud snoring.

• Episodes in which you stop breathing during sleep — which would be reported by another person.

• Gasping for air during sleep.

• Awakening with a dry mouth.

• Morning headache.

• Difficulty staying asleep, known as insomnia.

• Excessive daytime sleepiness, known as hypersomnia.

• Difficulty paying attention while awake.

• Irritability.

Sleep Paralysis :-
Sleep paralysis is when you cannot move or speak for a short
time after waking up or while falling asleep. It may last a few
seconds or a few minutes.

About 8 in every 100 people will experience sleep paralysis at

some stage. It might happen only once, or reoccur often. It
usually starts in adolescence and happens most often between
ages 20 and 40 years.

It does not cause any physical harm, but it can be scary.

During a stage of sleep called ‘rapid eye movement (REM)’ sleep, your body becomes temporarily
paralyzed. This means you can’t move your muscles. It may be your body’s way of preventing you from
acting out your dreams. Being paralyzed during sleep is normal, but you are usually unaware of it because
you are asleep at the time.

If this effect on your muscles from REM sleep continues after you wake up, you will be fully aware of being
paralysed .
Causes Sleep Paralysis :-

Sleep paralysis is not usually a sign of a problem. Sleep paralysis may occur on its own or it may be related
to other health conditions, including:

• high blood pressure

• mental health problems —in particular anxiety and post-traumatic stress disorder (PTSD)

• obstructive sleep apnoea

• narcolepsy — this is a brain problem involving extreme daytime drowsiness even when you’ve had
enough sleep at night

• alcohol or substance abuse

Sleep paralysis is also linked to:

• not getting enough sleep — for example, because of work hours or insomnia

• irregular sleeping patterns, for example those experienced by shift workers or students, or because of
jet lag

• family history of sleep paralysis

• sleeping on your back

The symptoms of sleep paralysis :-

During an episode of sleep paralysis, you are awake and aware of what is going on. Episodes can involve:

• not being able to move any part of your body, except your eyes

• not being able to talk

• feeling scared

• hallucinations — for example, feeling there is an intruder in your room or that something is pressing
on your chest or choking you

Complication

Sleep disorders can lead to a variety of complications that affect both physical and mental health. Here are
some common complications associated with sleep disorders:

1. Cognitive Impairment: Sleep disorders can lead to difficulties with attention, concentration, and memory.
This can affect work performance and daily activities.

2. Mood Disorders: Insomnia and other sleep disorders are often linked to anxiety and depression. Lack of
sleep can exacerbate these conditions, creating a vicious cycle.

3. Cardiovascular Issues: Chronic sleep deprivation is associated with an increased risk of hypertension,
heart disease, and stroke.

4. Obesity: Sleep disorders can disrupt hormones that regulate appetite, leading to weight gain and obesity.
5. Diabetes: Poor sleep can affect insulin sensitivity and glucose metabolism, increasing the risk of type 2
diabetes.

6. Weakened Immune Function: Sleep is crucial for a healthy immune response. Chronic sleep deprivation
can lead to increased susceptibility to infections.

7. Increased Risk of Accidents: Sleep disorders, particularly those that cause excessive daytime sleepiness
(like sleep apnea), can increase the risk of accidents at work or while driving.

8. Hormonal Imbalances: Sleep plays a critical role in regulating hormones, and disruptions can lead to
issues with growth, stress, and reproductive hormones.

9. Chronic Pain: Conditions like fibromyalgia and chronic pain syndromes can be exacerbated by poor sleep
quality.

10. Decreased Quality of Life: Overall, sleep disorders can significantly impact an individual's quality of
life, affecting social interactions, work-life balance, and overall well-being.

If you or someone you know is experiencing symptoms of a sleep disorder, it is important to consult a
healthcare professional for proper diagnosis and treatment options.

Obesity Hyperventilation Syndrome

Obesity Hypoventilation Syndrome (OHS) is a condition in which severely overweight individuals fail to
breathe properly, leading to increased carbon dioxide (CO ) levels and decreased oxygen (O2) levels in the
blood.

Causes:

• Excess weight puts pressure on the chest and lungs, making it harder to breathe.

• The brain may not properly regulate breathing during sleep.

• Reduced lung capacity due to fat accumulation around the abdomen and chest Symptoms:

• Daytime sleepiness and fatigue

• Shortness of breath

• Morning headaches

• Poor concentration and memory issues

• Loud snoring and frequent pauses in breathing during sleep

• Bluish skin (in severe cases due to low oxygen levels

Sleep-Related Hypoxemia
refers to low blood oxygen levels (hypoxemia) that occur during sleep. It can be caused by various
conditions that affect breathing, oxygen exchange, or circulation.

Causes of Sleep-Related Hypoxemia

1. Obstructive Sleep Apnea (OSA) – Repeated airway collapse leads to intermittent oxygen drops.
2. Central Sleep Apnea (CSA) – The brain fails to send proper signals to the breathing muscles.

3. Chronic Obstructive Pulmonary Disease (COPD) & Overlap Syndrome – COPD combined with sleep
apnea worsens oxygen levels.

4. Obesity Hypoventilation Syndrome (OHS) – Excess weight causes shallow breathing and poor
oxygenation.

5. Neuromuscular Disorders – Conditions like ALS or muscular dystrophy can impair breathing muscles.

6. Lung Diseases (e.g., Pulmonary Fibrosis) – Poor lung function leads to inadequate oxygen intake.

7. Heart Failure – Poor circulation can lead to low nighttime oxygen levels.

8. High Altitude Sleep Hypoxemia – Occurs in people sleeping at high elevations.

Symptoms

• Morning headaches

• Daytime fatigue or excessive sleepiness

• Restless sleep

• Shortness of breath at night

Treatment

• Continuous Positive Airway Pressure (CPAP)/BiPAP – Common for sleep apnea.

• Oxygen Therapy – Used for persistent hypoxemia in COPD or other lung diseases.

• Weight Management – Helps reduce the severity of OHS and OSA.

• Medications – For underlying lung or heart conditions.

• Adaptive Ventilation (ASV) – Helps in central sleep apnea.

Gerontological Nurses Role

Gerontological nurses play a crucial role in managing sleep disorders among older adults. Their
responsibilities include:

1. Assessment & Diagnosis

• Conducting comprehensive sleep assessments, including sleep history, sleep hygiene, and underlying
medical conditions (e.g., pain, depression, dementia, or medications affecting sleep).

• Using tools like the Pittsburgh Sleep Quality Index (PSQI) or Epworth Sleepiness Scale (ESS) to
evaluate sleep patterns.

• Monitoring for common sleep disorders such as insomnia, sleep apnea, restless legs syndrome
(RLS), and circadian rhythm disturbances.
2. Non-Pharmacological Interventions

• Educating older adults on sleep hygiene (e.g., maintaining a consistent bedtime, avoiding stimulants
like caffeine, and ensuring a comfortable sleep environment).

• Encouraging cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment instead of
medications.

• Promoting relaxation techniques like progressive muscle relaxation, meditation, or aromatherapy to

improve sleep quality.

• Supporting physical activity and daytime exposure to sunlight to regulate circadian rhythms.
3. Medication Management & Monitoring

• Collaborating with healthcare providers to review medications that may disrupt sleep (e.g., diuretics,
beta-blockers, or corticosteroids).

• Ensuring cautious use of sleep medications (e.g., benzodiazepines or sedative-hypnotics) due to risks
of falls, confusion, and dependence.

• Educating patients and caregivers about the risks of over-the-counter sleep aids and alternative
therapies.

4. Managing Underlying Conditions

• Addressing chronic pain, anxiety, depression, and nocturia, which can interfere with sleep.

• Assisting in the management of sleep apnea through CPAP therapy adherence and lifestyle
modifications.

• Recognizing and managing dementia-related sleep disturbances by maintaining structured daily

routines.

5. Caregiver Support & Education

• Training caregivers to recognize signs of sleep disturbances and apply behavioral strategies.

• Providing guidance on safe sleep environments to prevent nighttime wandering in dementia patients.

 Encouraging social engagement and meaningful activities to prevent daytime napping.

By implementing these strategies, Gerontological nurses play a key role in improving sleep health and
overall well-being in older adults.