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Chapter 5

Ch.5 part 2

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Wilfrid Laurier University
Mindi Foster

Problems in the Night: Sleep disorders 78 different types of sleep disorders Insomnia  Most common  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.  Causes:  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  Treatment:  the prescription of 2 classes of drugs:  benzodiazepine sedatives(Dalmane, Halcion, Restoril) – relieve anxiety  nonbenzodiazepine sedatives(Ambien, Sonata, Lunesta) – newer, for sleep problems  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  cognitive-behavioral therapy(CBT)  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 periods. 嗜睡 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- wave sleep) 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 asleep. 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 colleagues  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 virtual worlds.  most frequent types of dream: being chased or pursued, but not physically injured; sexual experiences  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 residue.  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 the unconscious.  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, problem-solving view)  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 ..  Procedure: 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 attention 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 Hypnotic Phenomena 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 are present  may also have their sensations distorted so that something sweet tastes sour or an unpleasant odour smells fragrant 3. Disinhibition  hypno
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