Problems in the Night: Sleep disorders
78 different types of sleep disorders
Refers to chronic problems in getting adequate sleep
difficulty in falling asleep initially
difficulty in remaining asleep
persistent early-morning awakening
(1→Young 2,3→middle age, elder)
... is associated with daytime fatigue, impaired functioning, elevated risk for accidents, reduced
productivity, absenteeism at work, depression, anxiety, substance abuse, hypertension, and
increased health problems.
Estimates of the prevalence vary considerably coz:
respondents’ highly subjective judgments
nearly everyone suffers occasional sleep difficulties
34-35% suffer insomnia, half of these people(15-17%)severe or frequent insomnia
prevalence ↑ with age, and 50% more common in woman
pseudo-insomnia/sleep state misperception → means they think they are getting an
inadequate amount of sleep
The discrepancy between individuals’ feelings about how much they sleep and objective
reality → consciousness are highly subjective.
excessive anxiety, tension
Insomnia is a side effect of emotional problems(depression, stress)
Health problems: back pain, ulcers, asthma
Use of certain drugs: stimulants(cocaine, amphetamines)
Primary cause→they have a higher level of physiological arousal than the average person
the prescription of 2 classes of drugs:
benzodiazepine sedatives(Dalmane, Halcion, Restoril) – relieve anxiety
nonbenzodiazepine sedatives(Ambien, Sonata, Lunesta) – newer, for sleep
both → help fall asleep, reduce nighttime awakenings, increase total sleep
Those sedatives – over used! Poor long-term solution!!
①have carryover effects – make people drowsy and sluggish
o overdose in combination with alcohol or opiate drugs
o more use → less effective→ people increase their dose→escalating
dependency and daytime sluggishness
②when people abruptly discontinue their sleep medication, they can
experience unpleasant withdrawal symptoms and increased insomnia.
o newer generation of nonbenzodiazepine reduced many problems
In conclusion!! Sedatives need to be used cautiously and conservatively.
Treatment programs: Relaxation procedures + behavioral interventions
more long-lasting benefits
70~80% who suffered benefit from it recognize and change negative thoughts and maladaptive beliefs
Other sleep Problems:
1. Narcolepsy is a disease marked by sudden and irresistible onsets of sleep during normal waking
a. from wakefulness to REM sleep for 10-20 minutes
b. potentially dangerous, fall asleep instantly
c. 0.05% of population, genetically predisposed
2. Sleep apnea involves frequent, reflexive gasping for air that awakens a person and disrupts
sleep. 睡眠呼吸暂停 (heart failure)
a. occurs when stops breathing for a min. of 10 secs.
b. defined by the presence of at least five such events per hour of sleep
c. loud snoring – 2% in woman, 4% in man, between age 30~60
d. excessive daytime sleepiness, hypertension, coronary disease, stroke
e. tripled individual’s mortality risk
f. Treatment: life style modifications(weight loss, reduced alcohol intake, improved sleep
hygiene), drug therapy, special masks and oral devices that improve airflow and upper
airway and craniofacial surgery
3. Nightmares are anxiety-arousing dreams that lead to awakening usually from REM sleep.
a. # nightmares and measures of well-being, ↑↑
b. where our negative memories and fear take central stage, reflect a failure in “emotional
regulation”, our ability to deal with our everyday experiences
c. persistent nightmares → emotional disturbance
4. Night terror/sleep terrors are abrupt awakenings from NREM sleep, accompanied by intense
autonomic arousal and feelings of panic. 夜惊
a. produce accelerations of heart rate, occur during stage 4 sleep early in the night(slow-
b. let out a piercing cry, bolt upright, stare into space
c. × recall dream, easy to return to sleep
d. occur in adults, and children aged 3~8
5. Somnambulism/sleepwalking occurs when a person arises and wanders about while remaining
a. occur during the first two hours of sleep, when in slow-wave sleep(last 15 sec to 30 min)
b. genetic predisposition
c. safer to awaken people
6. REM Sleep Behavior Disorder (RBD) is marked by potentially troublesome dream enactments
during REM periods.
a. talk, yell, gesture, fail about, leap out of bed during REM periods – chased/attacked
b. Dream are violent, often hurt themselves or bed partners.
c. occurs mostly in men who begin experiencing their problem in their 50s or 60s
d. people in REM sleep – virtually paralyzed → prevents dream enactments
e. Cause: deterioration in the brainstem structures that are normally responsible for this
immobilization during REM periods
f. coexist with some of the other sleep disorders
The World of Dreams
What is dream?!! Conventional view: …are mental experiences during REM sleep that have a story-like quality, include
vivid visual imagery, are often bizarre, and are regarded as perceptually real by the dreamer.
BUT: not as bizarre as widely assumed; not the exclusive property of REM sleep; Non-REM stage to be
less vivid, visual, and story-like; dreamer realize they are dreaming more often; mental process during
sleep are more similar to waking thought processes
The Contents of Dreams
..unfold in familiar settings with a cast of characters dominated by family, friends, and
We are more tolerant of logical discrepancies and implausible scenarios in our dreams than our
waking thought, but in our dreams we generally move through coherent sensible, realistic
most frequent types of dream: being chased or pursued, but not physically injured; sexual
female’s dream tend to negative(phobias: snakes, spiders), performance anxiety(failure),
control(loss of control)
children’s dream are different from adults’ dreams
o the rate of dream recall after REM awakenings is only 20-30% until ages 9-11
o children under age 5, mostly static, bland images with no storyline
o until age 11~13, children’s dream become adult-like
o →dreaming is a cognitive ability that develops gradually
Links between Dreams and Waking Life
what people dream about is affected by what is going on in their lives
o Not all daytime events are equally likely to affect dream content.
o Contents of waking life tended to spill into dreams; this spillover is labeled as day
The content of dreams can be affected by stimuli experienced while one is dreamed.
o ex. spray water on one’s hands while one’s dreaming, the dreamer had incorporated the
water into their dreams
o People’s dream world is not entirely separate from their real world.
Sometimes people may realize they are dreaming while still in the dream sate. – called lucid
dreams(which might be useful in the treatment of nightmares, control and influence the onset
of the lucid dreams)
Culture and Dreams
In Western cultures, dreams are largely written off as insignificant, meaningless meanderings of
Inuit Culture(far north of CA), shamans or angakoks had the power to ravel and visit hidden
places. (dreams viewed as important!!)
Aborigines Culture(CA, Australian), “Dreaming is the focal point of traditional aboriginal
existence and simultaneously determines their way of life, their culture, and their relationship to
the physical and spiritual environment.
The contents of dream vary somewhat from one culture to another because people in different
societies deal with different worlds while awake.
Theories of Dreaming
Why people dream?
1. Sigmund Freud: wish fulfillment
The day residue shapes dreams that satisfy unconscious needs 2. Rosalind Cartwright: provide a chance to work through everyday problems(cognitive,
We think through major problems in our lives
3. Hobson&McCarley: dreams are simply the byproduct of bursts of activity emanating
from subcortical areas in the brain.
Activation-synthesis model – side effects of the neural activation that produces
“wide-awake” brain waves during REM sleep.
downplays the role of emotional factors as determinants of dreams
A story is created to make sense of internal signals
Hypnosis 催眠: Altered Consciousness or Role Playing?
Greek word: sleep
Hypnotic induction and susceptibility
.. is a systematic procedure that typically produces a heightened state of suggestibility.
.. passive relaxation, narrowed attention, enhanced fantasy ..
1. the hypnotist will suggest to the subject that he or she is relaxing
2. subjects are told that they are getting tired, drowsy, or sleepy
3. the hypnotist vividly describes bodily sensations that should be occurring
4. subjects are told that their arms are going limp, their feet are getting warm, their eyelids
are getting heavy.
People differ in how well they respond to hypnotic induction.
o hypnotic susceptibility: can be estimated with the Stanford Hypnotic Susceptibility
Scale(SHSS) or its derivative, the Harvard Group Scale of Hypnotic Susceptibility.
o what makes people susceptible to hypnosis?
differences in personality traits(originally assumed)
①absorption: reduce/block peripheral awareness and narrow the focus of one’s
②dissociation: separate aspects of perception, memory, or identity(from the
mainstream of conscious awareness)
③suggestibility: accept directions and info. uncritically
o People who are responsive to suggestion under hypnosis are just as responsive to
suggestion without being hypnotized
their “hypnotic susceptibility” is not unique to hypnosis and is part of a boarder
trait characterized as imaginative suggestibility
1. Anesthesia 麻醉
withstand treatments that would normally cause pain
use hypnosis as a substitute for anesthetic drugs
hypnosis can be a surprisingly effective anesthetic in the treatment of both
acute and chronic pain
2. Sensory distortions and hallucinations 幻觉
hypnotized participants may experience auditory or visual hallucinations
hear sounds or see things that are not there, or fail to hear or see stimuli that
may also have their sensations distorted so that something sweet tastes sour or
an unpleasant odour smells fragrant 3. Disinhibition