2005

Physiology of Sleep
• Consciousness
• Reticular Formation
• Types of Sleep
• Normal Pattern of Sleep
• The Sleep-wake Cycle
• Sleep Disorders
 Consciousness
• Nervous system in operation – interactions
with the environment
• Other states
• sleep
• coma
• Present knowledge in biology
 Reticular Formation1
• Scattered → Medulla oblangata, pons,
midbrain
• Complex → nerve fibers associated with
tiny islands of gray matter (picture)
• System of nerve fibers → connecting
centres:
• Hypothalamus, basal nuclei, cerebellum,
cerebrum→ all major ascending and descending
tracts
 Reticular Formation2
• Sensory impulses→ activation of cerebral
cortex – state of wakefulness
• A filter
• The cerebral cortex as an activator
• Regulation of motor activities
 Types of Sleep1
• Two types of normal sleep:
• Slow-wave sleep (non-REM)
• Rapid eye movement (REM)
• Non-REM (70-90 min); four stages
• Transitional stage, normally lasts1-7 minutes
• Light sleep
• Moderately deep sleep (20 min after falling asleep)
• Deep sleep
 Types of Sleep2
• REM
• Most dreaming occurs
• Within 50-90 minutes of falling asleep
• Initially lasts 5-10 minutes, gradually
lengthens until final REM period lasts
50minutes
• Very important stage of sleep
 Normal Sleep Pattern
• During 8 hour sleep
• From stage 1 to 4 of Non-REM sleep
• Repeats stages 3 and 2→ Moves to REM
sleep
• REM and non-REM sleep alternate: sleep
period cycle repeats itself 3-5times
• In infants: 50% REM sleep
• In adults: 20% REM sleep
 The Sleep-wake Cycle
• The pineal gland signaled about the light-
dark cycle → regulation of melatonin
• Melatonin binds to major receptors on
cells of suprachiasmatic nucleus of the
anterior hypothalamus→ a region that
regulates the circadian clock
• Circadian clock regulates the sleep-wake
cycle
 Sleep Disorders1
• Insomnia - Inability to fall or remain in
sleep (10% of population)
• Narcolepsy - Abnormal REM sleep causes
extreme daytime sleepiness
• Parasomnias - Sleepwalking, sleeptalking

• REM-sleep behaviour disorder

 Sleep Disorders2
• Obstructive Sleep Apnea:
– Upper airway collapses repeatedly during
sleep, blocking breathing
– Causes snoring, daytime sleepiness and
sudden infant deaths
– Reported in some of the chronic illnesses:
• common in patients with end-stage renal disease
– Treatment for adults: nasal continues positive
airway pressure
 Sleep disorders3
• Restless-leg syndrome
• Sleep paralysis
• A shift in the circadian clock:
– Liver cirrhosis → Delay in the melatonin
increase and its peak nocturnal level
• Combination of neurochemical and
neurodegenerative changes
– Parkinson’s disease → alterations in stages
3,4 and REM sleep
 Implications for nursing
• Creating a safe and peaceful environment
• Plan your duties/tasks for the night
– Timing:
• Medications, interventions (observations, fluid
therapy)
• Fluid and NG pumps (check what time bags needs
to be changed)
• Different patients have different sleeping
habits (early/late ”sleepers”)
– ear plugs, sleeping tablets