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Chapter 5

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PSY 111

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 consciousness. 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 exhibits  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  Sleep-Wake Cycle o Many possible triggers. Mostly light and dark (registered in part by SCN) and melatonin.  Body Temperature 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)  Heart Rate  Hormone Levels  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 and children 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  Measurements  EKG  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, occipital) o Electro-oculograph [EOG]—corner of eye. 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  Blood Pressure  Hormones  Core body temperature (rectal thermometer)  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, Delta 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 stages) 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  REM Sleep 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 are paralyzed) 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)  Sleep Parameters 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 asleep. 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 fine.  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)  Uniphasic—1 episode  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 background. 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 groggy.  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. Insomnia  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.  Risk Factors 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 awakenings) 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.  Treatments 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 awake.  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 dependence.  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. o Benzodiazepines  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, Xanax  Generally useful in short-term, especially for people with anxiety.  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) o Antidepressants  No FDA approved nor proven effective for treating insomnia (off-label use)  Do seem to help (especially depressed patients)  typically given in low doses  Prozac  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  Rozerem  Not well tested  May be effective with elderly who naturally produce less melatonin  Not a first-choice, typically  Claims are probably over-exaggerated (Placebo effect) o Stimulus Control of Sleep-Onset Insomnia  Rules  Do nothing in bed other than sleep  Go to sleep only when sleepy  Get out of bed if you cannot sleep within 20 minutes  Do not nap  Wake up and go to bed at the same time  May make insomnia worse at first, but it will get better in weeks. Hypersomnia (excessive daytime sleepiness)  Narcolepsy [Narce=numb, lepsis=attack] o Symptoms  Cataplexy [cata=down, plexis=strike]: Attack of REM sleep. loss of muscle tone. Brought on by strong emotion  Cataplexic fit you can‘t move or speak but you can hear  Hypnogogic hallucinations—very vivid visual experiences upon awakening (Dreaming while awakening)  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 o Treatment  Amphetamines and antidepressants: Modafinil  No cure  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 breath 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  Daytime Sleepiness  Cognitive problems: memory, learning, reaction time, concentration  Caused by lack of sleep and oxygen deprivation  Diabetes 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 apnea 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. o Treatments  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 o Treatment  Drugs (expand the bladder. Side effects include irritability).  Pad and buzzer  Sleepwalking (somnambulism) 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 o Treatment  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 to mankind‖ o Primarily young children (single digit frequency ~3%) but can occur in adults o Usually occurs just once or a few times—no treatment required 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  Nightmares 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 (especially Parkinson‘s) 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 adolescents o Occurs out of NREM sleep (because during REM you are paralyze) o May take turns as if engaged in conversation  Bruxism 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 Dreams  Freud 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 dream. o believed everything is motivated by sex and aggression. o Functions of dreams  Guard our sleep  Wish fulfillment  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 them.  Cohen and Wolfe o Resarch (1973)  Population: female college students  Independent Variable  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 ½.  Dream Recall is affected by interference rather than repression  Calvin Hall o wrote The Content Analysis of Dreams o ―A skillful man reads his dreams for self-know
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