Sleep

• Around 4 in 10 people are not getting enough sleep
• 1 in 5 sleep pooriy most nights
• Sleep is the second most common health complaint after pain, potentially having a significant impact on the nations health. Given sleeps pivotal role, it needs to be a key priority for the publics health.

• Insomnia- Trouble falling and/or staying asleep
• Hypersomnia-  excessive time spent sleeping or excessive sleepiness.
• Narcolepsy- diminished capacity to control sleep wake cycles.
• Sleep apnoea- where breathing is interrupted
• Parasomnia- abnormal or unusual behaviour of the nervous system during sleep.
• Circadain rhythm sleep disorder- which affects the timing of sleep 

• Sleep is a state of natural unconsciousness from which one can be aroused
• Sleep forms part of a natural rhythm of life, any single cell taken from out body and placed in isolation in a laboratory dish will maintain a stable 24 hour pattern, demonstrating that sleep is a force to be harnessed rather than challenged. 
• Opposing or disrupting sleep and this rhythm of life can be very harmful

• Sleep has been shown to be an essential component of health, affecting the wellbeing and quality of individuals.
• Sleep is one of the most important factors to maintain good mental and physical health, there are many essential physiological processes that occur during sleep.
• It is a basic human need

• After just a short period of reduced sleep, people are more vulnerable to infection and respond less well to vaccination
• Brain function worsens, in particular attention, drastically increasing the risk of accident and injury
• In younger children and older adults, longer periods of sleep loss can significantly impair learning and cognitive processing
• Those who consistently fail to get enough sleep face increased risk of hypertension, coronary heart disease, CVA (cardio vascular accident/ stroke) and death.

Physical- risk of: Cancer, cardiovascular disease and stroke, Disorders of the hypothalamic pituitary adrenal (HPA), Metabolic abnormalities, Weight gain & obesity ,Reduced immunity, Bodily sensations of pain, Thermoregulatory problems, Vulnerable seizure threshold

Mental- risk of: Depression, psychiatric relapse, mood fluctuation, delirium, impulsivity, anger and frustration, higher risk of suicide, anxiety and hyperarousal, chronic fatique

Behavioural- risk of: sleepiness, road traffic accidents, falls and fractures, repeat prescribing, alcohol and drug dependency,  increased sedative and stimulant use, less likely to attend appointments, longer stay in hospital, earlier admission to long- term care

Performance- risk of: impaired attention and concentration, decreased memory, reduced multi-tasking, impaired decision making, reduced creativity, reduced communication, reduced socialisation, less likely to be employed, more likely to be on benefits

Two processes regulate sleep duration, quality and timing and determine a persons degree of "morningness" or "eveningness"

• Circadian timing- generates 24 hour bodily rhythms, adapted to earth light/dark cycle. Defined as periods of sleepiness and wakefulness and schedule many other physiological processes, preparing the body for activity during the day and rest at night
• Cells in the body are regulated by molecular clocks, synchronsied through hormones, such as cortisol and melatonin, and neuronal signals. These synchroise with the outside would primarily through light, acting on the brain, and through the timing of meals, physical activity and social cues.
• Sleep-wake homeostasis- increases (or decreases) the pressure to sleep with the time spent awake (or asleep). Its not fully understood but may involve the levels of the chemical adenosine in the brain. These processes are genetically determined and interact with each other and with each persons environment and behaviour

Not yet fully understoof but it likely involves saving energy, restoring the body and brain, and/or organising networks in the brain, such as learning and memory.

One theory suggests that by reducing the energy used for sleep frees up energy for these much needed brain functions, as well as processes essential to survival such as tissue growth and the function of the immune system

• The cycle of sleep stages repeat 4 to 5 times a night
• The amount of time spent in delta sleep decreases later in the night and more and more time is spent in stage 2
• The first REM period may last 10 minutes and, later the REM periods may be up to 1 hour long
• The interbals between REM periods decreases from 90 minutes earlier in sleep to around 30 minutes towards the morning.

• Environmental
• Pain 
• Anxiety and stress

As a healthcare professional we can promote sleep of patients/clients in our care:

• Knowing thier routines where possible adhere to them
• Lighting- day/night- timing
• Noise- reduction where possible
• Drinks- milky drinks/ drinks close at hand 
• Comfort/privacy
• Temperature
• Think do we need to do this now
• Adequate pain relief
• Ear plugs/ eye masks