Consciousness—a person‘s awareness of feelings, sensations, and thoughts
at a given moment. Components include wakefulness and awareness.
Persistent Vegetative State—Damage to thalamus or its cortical
connections causes wakefulness without awareness.
Altered State of Consciousness—a form of consciousness that is
different from normal, waking consciousness.
o Daydreaming—a form of consciousness involving fantasies,
usually spontaneous, that occurs while a person is awake.
o Use of alcohol or drugs can result in an altered state of
o Anesthetic awareness—occurs when surgical patients are
conscious despite anesthetic. ~1 in 1,000
Bispectral Analysis (BIS)—monitors:
Type and percentage of brain waves a patient
Percentage of isoelectric activity (no brain
activity) as anesthetic depth increases
Circadian rhythms [circa=about, dies=day]—internal biological changes that
occur on a daily schedule
o Many possible triggers. Mostly light and dark (registered in
part by SCN) and melatonin.
o Our core body temperature changes about 2-4 degrees in 24
hours. Highest point, you are most alert. Lowest point
(usually ~4 a.m.) you should be sleeping.
o Owls and Larks (When you sleep and when your temperature
cycle reaches its high point)
Chronobiology—science of investigating and applying information
about biological rhythms.
Suprachiasmatic nucleus (SCN)—pin-head sized collection of
~20,000 neurons located in the hypothalamus (just above the optic
chiasm). Receives information about light and dark and serves as a
central internal clock.
Problems with Circadian rhythms
o Jet Lag—temporary maladjustment that occurs when a
change of time zones causes biological rhythms to be out of
step with local time
o Shift Work Sleep, Sleep Disorders, Dreams
Breakthroughs in Sleep Research
Noticing eye movement during REM
Development of EEG in 1929 by Hans Berger
o Measures electrical activity in the brain
o In ~1929, they believed there were 5 stages of sleep
Aserinsky and Kleitman (University of Chicago, 1955) Association of
a specific sleep stage with dreaming
o Kleitman was considered ―Dean of Sleep studies‖
o Aserinsky was Kleitman‘s grad student
o Kleitman believed in eye movement during sleep. Asked
Aserinsky to monitor eye movement during sleep of adults
o REM occurs in most about 3-6 times per night
o Awoken from REM, 74% say they were dreaming
o Awoken from Non-REM, 7% say they were dreaming
o Most eyes move left to right, sometimes up and down
o Eyes sometimes move in opposite directions during sleep if
someone is severely sleep deprived.
o Night in Sleep laboratory
If you suffer a heart attack, it is more likely
to be during REM
Polysomnograph [poly=many, somni=sleep,
graph=written/drawn]—connected to the
electrodes and monitors them.
o EEG (3 placements: frontal, central,
o Electro-oculograph [EOG]—corner of
o EMG—chin and others
o When you are in REM sleep, muscle
tone is gone (otherwise you would be
acting out your dream) (one of the
first places to lose movement is chin
Core body temperature (rectal
Penile erections and vaginal lubrication
Sexually aroused during REM slee
Blood flow (especially in the brain) Breathing (sleep apnea)
What we‘ve learned (at this time)
o EEG brain waves: Beta, Alpha, Theta,
o 5 stages of sleep: Stages 1,2,3,4, and
REM (Now changed to 1,2,SWS,REM)
Stages of Sleep
NREM Stages (it becomes harder to awaken people out of deeper
o Stage 1: 2-5% Threshold of sleep/very light
o Stage 2: 50% No idea what this does
o Stage 3: 3-8% SWS (Slow Waves Sleep) Delta
o Stage 4: 10-15% SWS or delta
Changes in how sleep stages are scored
o Done by computer
o Stages 3 and 4 are now combined as SWS (20% or more of
waves are delta)
o Stage W (formerly Stage 0) is awake
Important indicator of insomnia, sleep disorders
o Sleep arousals (brief but significant)
Have no memory of this. Average 4-8 times
o EEG looks like that of an awake person
o Very hard to awaken someone out of REM
o High rate of blood flow in the brain (highly active)
o Rapid eye movement (back and forth)
o Sexually aroused
o Muscle Paralysis (Paradoxical Sleep—brain is active, muscles
o Dreams (only in REM?)
o If you deprive someone of REM, their body tries to get back.
o Average adults spends 20-25% in REM
o Newborns spend 50% in REM
o Premature babies sleep 75% in REM (Can we monitor this in
unborn babies?—What would it look like?)
o Endogenous stimulation (Theoretical Explanation)—babies
provide their own stimulation via REM. Probably necessary
for complete brain development
Infrastructure of sleep
Descending Stages 1-4 (~45 minutes)
Stage 4 (Night terrors, sleep walking, etc,)
Ascending through 3,2, possibly 1 REM (first REM period is short [~5-10 mins] gets longer as night
goes on. [if you sleep 10 hours, last REM can be ~30 minutes])
This entire process is 1 sleep cycle. ~90-100 minutes
REM increases across night, SWS decreases (negative correlation)
o Length—average American adult sleeps 7 hours. We are
generally sleep deprived
Hyposomnia: very little sleep ~4 hours or less. This is
not Insomnia. A person with Hyposomnia will not
complain about reduction in sleep (Manic periods of
Bipolar disorder), people with Insomnia will complain
about reduction of sleep
Hypersomnia—lots of sleep st
o Sleep in babies: 10-22 hours per day (1 day of life)
Chronic Sleep Deprivation:
Why do we sleep?
o SWS allows rest and repair. (Starvation, surgery, and other
physical demands lead to increases in SWS).
o Brain can repair itself during NREM, but not REM (it cannot
repair itself when it is very active).
o During REM sleep, release of neurotransmitters
norepinephrine, serotonin, and histamine ceases. The brain
cells creating these need this break.
If neurotransmitters were active all of the time,
receptors would become desensitized.
o REM may play a role in memory consolidation.
o REM provides stimulus.
Self-Survey: 20% adult population sleeps less than 6.5 hours
National Sleep Foundation: survey of 1,000 adults
o 15% report less than 6 hours
o 10% report less than 6 hours on weekends
We are generally sleep deprived (we sleep ~1 hour less on average
than at the beginning of the 19 thcentury)
Multiple Sleep Latency Test—try to fall asleep every 2 hours during
normal awake hours. If you can fall asleep easily, you are probably
tired. Most people may not know what it feels like to be fully alert.
Sleep Efficiency index—percentage of bed time actually spent
o 95% among people in 30s
o 80% among people in 70s
Elderly spend more time in lighter stages of sleep,
which causes easy awakenings. Sleep Inertia—a temporary feeling of impairment that follows
awakenings of naps
Story of Peter Tripp. 1959, decided to raise money for March of
Dimes by staying awake 200 hours (8 days). By the third day, his
behavior changed. He began to abuse everyone (cursing, mean,
etc.), could not say the alphabet or count to ten, body temperature
declined. The lower his temperature, he began to get crazier. He
began to hallucinate; his brain waves looked like REM sleep even
though he was awake, which is when he would hallucinate.
Dreaming while awake. After 200 hours awake, he slept for 24
hours. The delusions were gone, and he thought he was back to
normal, but others said he was permanently changed.
Sleep deprivation used as a form of torture during wars
Randy Gardner, high school student, decided to go 264 hours
without sleep. After 100 hours, he was still alert enough to play
games. At the end, his eyes began to go different directions. He
said it was all ―mind over matter‖. He slept 13 or 14 hours and was
World record is slightly beyond 264 hours
Total sleep deprivation is very rare.
o Microsleeps—sleep while standing up for just a few seconds.
Exception: Fatal Familial Insomnia (FFI)—true total sleep
deprivation. Cannot sleep at all. They die, as a result.
Number of Episodes of Sleep
Polyphasic—several episodes of sleep in 24 hours
Biphasic—2 episodes. (Like night and nap)
Babies make no distinction between night and day, no distinction
between sleep and nap.
o Begins Polyphasic. Consolidates around 4 months
o During consolidation is highest rate of Sudden Infant Death
Syndrome. (SIDS) possible problem is that infant breathes in
carbon dioxide that they have just exhaled (Back-sleeping
helps prevent this)
o Munchausen Syndrome—psychiatric disorder where a person
inflicts medical syndrome on himself or someone else.
Munchausen by Proxy—parent (usually mom) causes
symptoms in baby.
Munchausen tends to occur in people with a medical
Types of Naps in adults
Replacement nap—gone without sleep, and tries to make it up Appetitive nap—biological need. Naps on a normal basis.
The longer a nap is, the more likely that you will wake up slightly
Placement of sleep in the 24-hour cycle.
o Importance of temperature.
Our core body temperature changes about 2-4 degrees
in 24 hours. Highest point, you are most alert. Lowest
point (usually ~4 a.m.) you should be sleeping.
o Owls and Larks (When you sleep and when your temperature
cycle reaches its high point)
Sleep Disorders—divided into Insomnia, hypersomnias, and parasomnias.
1. Low # of hours of sleep (In common with Hyposomniacs but
Hyposomniacs will not complain)
2. Tired, difficulty concentrating, may doze off during the day.
Pseudoinsomnia—looks like insomnia, victim probably thinks they
have insomnia, but sleep clinic will show that they do not. They
believe they are insomniac, but they actually get enough sleep.
o More women than men
o Older people have increased chance. (Older people spend
more time in Stage 1 sleep, and it is easier to awaken
someone out of stage 1)
o Ethnicity: higher rate among African Americans
o Genetics plays a small role
o Medical Comorbidities (More than one disorder)—if you are in
pain, you will probably not sleep well.
Types of Insomnia
o Length of time that Insomnia has existed
Transient or acute—days
Chronic—weeks or months
o Sleep Onset Insomnia—most people should fall asleep within
15 or 20 minutes. (Problem: ongoing monologue)
o Multiple Awakenings (MA)—wakes up (not normal brief
o Early Morning Awakenings (EMA)—This is particularly serious.
Awakens very early (like 4 a.m. and cannot get back to
sleep). Associated with depression and sometimes suicide.
o Over-the-Counter Medications: Sleep-eze, Nytol, etc.
Based on Histamine (a drug the body naturally
produces) and Antihistamine (which is in the drug) Histamine is a neurotransmitter and a protein. It is
produced to fight allergents (found in Benadryl, etc.)
Histamines work in the part of the brain that keeps us
Anithistamines block histamines to put you to sleep. (or
at least make you drowsy)
―reasonably effective in helping people fall and stay
asleep after a single administration‖. But, little
research on long-term effectiveness or safety.
Problems: morning hangover, tolerance, and
Side effects: nausea, dizziness, gastric distress, dry
mouth, disturbed coordination
o Barbiturates—powerful drugs that work on GABA
Warnings: reduced sleep quality, morning hangover,
tolerance, highly addictive, suicide (intentional or
unintentional. Particularly if one mixes alcohol with
barbiturates), REM rebound (Barbiturates reduces the
total amount of REM, and if you go off them, you will
get more REM than before and the eye movement will
be faster. So, you have insomnia returning and you
may have nightmares)
―Today, sleep experts rarely prescribe Barbiturates‖
o Alcohol is also a REM depressant.
Work on GABA (GABA reduces anxiety)
5 FDA approved for short-term insomnia. Dalmane,
Restoril, Halcion, etc.
4 are approved for treating anxiety that are used to
treat insomnia (off-label use) Clonazepam, Ativan,
Generally useful in short-term, especially for people
Drawback: reduced deep (slow wave) sleep, morning
hangover, tolerance, dependence (not nearly as much
of a problem as with Barbiturates)
Generally safe unless mixed with alcohol (although,
really, don‘t mix any drug with alcohol)
Side effects: unsteadiness, dizziness, amnesia
Date-rape drug falls under this category.
o Nonbenzodiazepines Hypnotics [Hypnos—Greek God of sleep]
Also enhance GABA, but slightly different chemical
composition than Benzodiazaphine
Act only on brain receptors focused on sleep Ambien, Sonata, Lunesta
Act quickly and wear off quickly
Only Lunesta has been tested up to 6 months (the drug
company funded the research)
No FDA approved nor proven effective for treating
insomnia (off-label use)
Do seem to help (especially depressed patients)
typically given in low doses
Reduces sleep latency and nighttime arousals
Won't wake up through the night
o Melatonin Receptor Agonist
First new class of sleep medication drugs in 30 years
Not well tested
May be effective with elderly who naturally produce less
Not a first-choice, typically
Claims are probably over-exaggerated (Placebo effect)
o Stimulus Control of Sleep-Onset Insomnia
Do nothing in bed other than sleep
Go to sleep only when sleepy
Get out of bed if you cannot sleep within 20
Do not nap
Wake up and go to bed at the same time
May make insomnia worse at first, but it will get better
Hypersomnia (excessive daytime sleepiness)
Narcolepsy [Narce=numb, lepsis=attack]
Cataplexy [cata=down, plexis=strike]: Attack of REM
sleep. loss of muscle tone. Brought on by strong
Cataplexic fit you can‘t move or speak but you
Hypnogogic hallucinations—very vivid visual
experiences upon awakening (Dreaming while
Excessive daytime sleepiness Sleep Paralysis—muscle tone is gone. If you awaken
out of REM sleep, you know that you are awake but
cannot move (you can have this without narcolepsy)
o Genetics may play a small role, but not much
o Usually begins in adolescence or early adulthood.
o 0.05% of population
Amphetamines and antidepressants: Modafinil
Naps can reduce symptoms.
Sleep apnea—[Greek=absence of breathing]—flow of air to the
lungs stops for at least 10 seconds.
o Central Apnea—brain is not sending messages to the lungs to
o Obstructive Apnea—obstruction in the wind pipe (far more
common than central apnea)
o Screening Test
Snoring—almost everyone with Sleep Apnea snores
40% of adults snore, more men than women, but
snoring increases among women later in life.
Thick neck (Men: 17 inches. Women: 16 inches)
Hypertension and Cardiovascular problems
Cognitive problems: memory, learning, reaction time,
Caused by lack of sleep and oxygen deprivation
o Until 1993, it was believed to be uncommon. No longer.
o Higher probability in men and obese people.
o Now, it is suspected to be grossly under-diagnosed.
University of Wisconsin Medical School Study: 600 state
employees (30-60 years old)
9% of women and 24% of men had at least 5
episodes per hour
4% of men and 2% of women have full syndrome
o Habituate to repeated awakening, complain of insomnia, risk
of heart-related disorders.
o Must be careful with medication if you are treating insomnia
and someone really has sleep apnea.
Early surgical interventions (for Obstructive apnea)
Trachiotemy to put a hole in wind pipe. CPAP (continual positive airway pressure) (preferred
treatment). Mask that opens lungs and air passages.
Laser surgery—if an individual has excess tissue in the
back of his throat, it can be removed
Parasomnias—occur more frequently in children than adults
Enuresis (bedwetting)—generally diagnosed after age 5. Far more
frequent in males.
o Children have an elevated arousal threshold so it is harder to
awaken after bedwetting.
o Mostly occurs in NREM sleep, no particular stage.
o Occurs most often in boys
o Improves/goes away with maturing CNS
Drugs (expand the bladder. Side effects include
Pad and buzzer
o Children and adolescents, especially (15%)
o Occurs in 1-17% of people
o Occurs out of SWS sleep cycle (first time you hit SWS is ~45
minutes after start)
o Disappears with time in most cases
o Person has alpha waves and delta waves at the same time
Drugs—not recommended because drugs take away
SWS which is an especially bad idea in children because
SWS emits growth hormone
Home modification—lock doors,
Don‘t awaken sleep-walker. Direct them back to bed.
Sleep and Night Terrors
o Night or Sleep Terror ―the most frightening experience known
o Primarily young children (single digit frequency ~3%) but can
occur in adults
o Usually occurs just once or a few times—no treatment
o Occurs out of SWS (especially stage 4) so it can occur with
stage walking, and does so especially in children
o Heart rate increases threefold in one minute
o Overwhelming physiological arousal
o Recall in absent in children, but may be present in adults
(terrifying reports) o Treatment: in most cases, passes with time (especially in
children). Goes away with maturing CNS
o Occur out of REM (usually at the end of the night)
o ~90% of people
REM sleep interruption insomnia can occur if the anxiety
associated with nightmares is too strong.
REM sleep behavior disorder (RBD)
o May look like sleepwalking, but occurs out of REM. (also,
older than sleepwalkers, usually)
o Normal skeletal paralysis does not occur in these people, and
they act out their dreams.
o Can hurt themselves or others
o Tends to occur in men (90%)
o Later in life, especially starting in 50s.
o ~0.5% of people have this disorder
o May be a forerunner of degenerative brain disorders
o Can be successfully treated almost always
Benzodiazopimes most common Clonazopam—reduces
or eliminates symptoms 90% of the time
Somniloquy (Sleep talking)
o Rarely considered a sleep disorder
o Occurs across the lifespan, but more often in children and
o Occurs out of NREM sleep (because during REM you are
o May take turns as if engaged in conversation
o Teeth grinding during sleep (nocturnal bruxism)
o Serious dental problems—teeth can be worn down to gums
o Treatment: mouth guard or drugs
Sudden Infant Death Syndrome (SIDS)
o Most common form on death between 1 month and 1 year
o Mostly occur at 2-4 months
o Risk factors: sleeping on stomach, recent illness, soft
mattress, elevated room temperature
o Sleeping on back may help
o ―Dreams are the royal road to the unconscious‖ –Sigmund
Freud o Manifest Content—what you consciously remember when you
awaken, the ―cleaned up‖ version
o Latent Content—the raw, crude, underlying meaning of your
o believed everything is motivated by sex and aggression.
o Functions of dreams
Guard our sleep
Eros [life] pleasure sex
Thanatos [death] aggression
o Importance of Symbols—meant to hide the true meaning
Male organs: 102 symbols (sticks, spears, knives, etc.)
Female organs: 95 symbols (rooms, boxes, chests, etc.)
Intercourse: 55 symbols
o Repression—the reason we forget out dreams. We sweep
them into unconsciousness because we don‘t want to face
Cohen and Wolfe
o Resarch (1973)
Population: female college students
Control group writes down dreams immediately
Experimental group calls weather bureau upon
awakening and writes down the weather, and
then writes down dreams
Dependent Variable: Dream Recall
Calling weather bureau decreased dream recall by
Dream Recall is affected by interference rather than
o wrote The Content Analysis of Dreams
o ―A skillful man reads his dreams for self-know