Sleep Hx

 

Index

 

-  Sleep History

-  Sleep Hygeine

-  Infant sleep patterns

 

Features

-  Avg adult requires 7.5-9 hrs/day

-  Newborns 0-2/12: 12-18 hrs/day

-  Infants 3/12-1yr: 14-15 hrs/day

-  Toddlers 1-3yrs: 12-14 hrs/day

-  Preschoolers 3-5yrs: 11-13 hrs/day

-  Children 5-12yrs: 10-11 hrs/day

-  Teens 12-18yrs: 8.5-10hrs/day

-  Sleep divided into REM & NREM cyles

-  Non REM (NREM) sleep

-  1. Transition: 5min +/-

-  2. Light sleep: 10-25min, body temp & HR drop

-  3. Deep sleep: difficult to awaken

-  4. Intense Deep sleep

-  REM sleep

-  Within 70-90min of falling asleep

-  Dreaming occurs

-  HR & BP increase

-  Muscles paralysed (except eyes)

 

Infants Sleep Pattern

-  0-3months

-  95% sleep during day

-  1/2 to 1hr to settle

-  Awake up to x6 per night (usually x2)

-  1yrs

-  90% daytime nap 1-2hrs

-  6-8pm settle, 80% quickly

-  60% night time waking

-  10% >3 times per night

-  2yrs

-  50% daytime nap

-  37% sleep after 8pm

-  25% take 30min+ to settle

-  50% wake x1 per night

 

Presentations

-  Insomnia

-  Somnolence

-  Sleep wake-cycle disturbance

-  Nightmares, Night terrors

-  Restless Leg syndrome

-  Sleep walking

-  OSA

-  Snoring

 

Sleep History

-  Time to bed/sleep

-  Time or awakening/arising

-  Bedtime rituals

-  Beliefs about sleeping/not sleeping

-  Use of stimulants/EtOH

-  Sleep environment

-  Temp, noise, light, comfort..

-  TV in room

-  Medical conditions & Rx

-  Arthritis, insomnia..

-  Exercise

-  Eating habits

 

Sleep Hygeine

-  Wind down

-  Avoid stimulants

-  Cool, dark & quiet environment

-  Time or rising set by body clock

-  Exercise

-  Control nocturnal worry

-  Number of hours sleep

 

Ix

-  +/- sleep studies: OSA, restless leg syndrome

 

Mx

-  Sleep diary

-  1-2 weeks as a guide

-  Avoid making the focus for pt

-  Address medical factors

-  Insomnia

-  Stimulus control

-  If not asleep within 15 min+/- get out of bed

-  Bed for sleep & sex only (not TV or reading)

-  Sleep restriction

-  Calculate time spent sleeping each night

-  Restrict time in bed to that amount of time only

-  Requires more effort from pt

-  Benzodiazapines as last resort

-  Temazepam

-  Flunitrazepam: potent, drug of abuse