Exam 2

Question 1

What impact does sleep deprivation have on hypertension?

Answer 1

• With sleep deprivation, it can cause millions of lives lost due to hypertension. Deep NREM sleep helps manage blood pressure and can prevent you from having cardiac issues as well as issues with hypertension. Losing one hour of sleep or so can increase your blood pressure. Sleep deprivation increases your heart rate and erodes coronary arteries.

Question 2

How does sleep deprivation impact the sympathetic nervous system?

Answer 2

• The sympathetic nervous system is responsible for the fight or flight instinct. Having an overactive sympathetic nervous system can cause your heart to beat faster when a stress hormone is released. The normal brake that is there that stops accelerated heart rate will be released and you will experience accelerated heart rate. An overactive sympathetic nervous system will release a stress hormone called cortisol which will cause an even greeted increase in blood pressure.

Question 3

How does sleep loss impact blood sugar and the development of Type II Diabetes?

Answer 3

• Whenever we lose sleep, our bodies will stop producing insulin. Your body’s cells resist the message from insulin and refuse to open up surface channels. Basically your body becomes far less receptive to insulin.

Question 4

How does sleep deprivation influence leptin and ghrelin?

Answer 4

• Sleep deprivation makes the hormone leptin decrease which is the hormone responsible for making us feel full. While it makes the hormone ghrelin increase which makes us want to eat more.

Question 5

Why is it that we crave quick-fix sugars and complex carbohydrates when we are sleep deprived?

Answer 5

• The prefrontal cortex which is responsible for judgment and decisions are silenced after sleep deprivation. While the primal deep brain structures that drive motivations and desire are activated more. Top that with an increase in the hormone leptin and you will see more individuals who crave more sugars and carbohydrates.

Question 6

Know some research examples of how sleep deprivation impacts the reproductive system in males and females.

Answer 6

• If you take young healthy males and limit them to five hours of sleep for one week you will see a decrease in testosterone and can decrease sperm count. For sleep deprivation in women, they will have significantly higher rates of abnormal menstrual cycles. Women who are sleep deprived also struggle with fertility issues which can cause issues with getting pregnant.

Question 7

v Know Dr. Irwin’s study on how short sleep influences your cancer-fighting immune cells (p. 184).

Answer 7

Dr. Irwin examined healthy young men and found that a single night of four hours of sleep, swept away 70 percent of the natural killer cells circulating in the immune system. Natural killer cells are responsible for targeting cancer cells.

Question 8

What role does the posterior cingulate cortex and frontoparietal cortex play in sleepwalking? (Hint: See the SPECT study discussed starting on page 40).

Answer 8

• During a sleepwalking episode, a deep area of the brain called the posterior cingulate cortex was found to be more very active, while another area, the frontoparietal cortex, showed significantly reduced activity compared to wakefulness. The cingulate cortex is involved with the control of behavior associated with strong emotions. The frontoparietal cortex goes hand in hand with the prefrontal cortex which is associated with rational thinking. Basically your emotion side of your brain is in overdrive and almost awake and the part of the brain associated with logic is deep asleep.

Question 9

v What is the origin of the fight or flight response in some sleepwalkers?

Answer 9

• The cingulate cortex which is a part of the limbic system is responsible for this feeling. With this area being active, it causes adrenaline to increase that feeds into more sleepwalkers dreams.

Question 10

v Why do some adults sleepwalk and others do not?

Answer 10

• Scientists do not have a clear answer on this matter. However what they do know is that adults who sleepwalk often have other members in their family that do the same. However sleepwalking can be triggered by some people by daytime stress and alcohol. Another possibility is that sleepwalkers sleep more soundly than non sleepwalkers. With sleep deprivation and when you finally get sleep, it will make deep sleep even deeper.

Question 11

v What is REM sleep behavior disorder?

Answer 11

-You physically act out vivid dreams. But you do not get out of bed, you may twitch a little bit or move your arms. RBD is more likely to happen a few hours before waking

Question 12

v Know the Jouvet cat experiment – page 65.

Answer 12

• Damage to the brainstem caused cats in REM to hiss, walk, fight or behave as if they were chasing prey. Their brain activity showed they were in REM sleep, however they did not have muscle paralysis.

Question 13

Why is RBD considered a precursor (in some) to neurodegenerative conditions, like Parkinson’s and Lewy Body Disease?

Answer 13

• Deposits of a protein called the alpha-synuclein is found in the brain stem which is responsible for Parkinson’s disease and in the area responsible for switching on the paralysis seen in REM sleep. So they can go hand and hand.

Question 14

v What do people with RBD usually dream about? Why?

Answer 14

• Dreams of being attacked or fighting or running away. Dreams that have to do with movement. Research shows that individuals who have parkinsons and RBD are less aggressive during the day than those with just Parkinson’s. Changes in the brain stem give rise to thrashing movements while dreaming. In the same way we integrate sensory stimuli into our dreams, a clap of thunder may be interpreted into an explosion, etc. Basically what we hear while were dreaming can morph into something scary causing people with RBD to act out more.

Question 15

v Define paradoxical kinesis.

Answer 15

• Movement becomes possible under life-threatening circumstances. Like something who can’t move can all of a sudden move to escape a fire. With RBD patients sometimes the strong emotional content of their dreams can override their Parkinson’s disease.

Question 16

v Why does the author think we are living through a sleep apnea epidemic?

Answer 16

• The rates have increased dramatically throughout the years because of the percentages of adults who are overweight or obese. In the United States, the rate of obesity has increased since the early 1980’s.

Question 17

v What are some of the physical and mental consequences of sleep apnea?

Answer 17

• Physical= High blood pressure, heart disease, stroke, feeling constantly tired
  -Mental= Increase of Stress and depression.

Question 18

v What is the relationship between sleep apnea and Alzheimer’s Disease?

Answer 18

• Sleep apnoea causes an increase in deterioration in cognition, vigilance, long-term verbal and visual memory, reasoning and problem-solving. Build up of the protein beta-amyloid has been associated with sleep apnoea. The protein is deposited in the brain, forming plaques that cause signaling issues and ultimately cause inflammation within the brain.

Question 19

What are some treatments for sleep apnea?

Answer 19

Weight loss helps. Keeping some patients off their back, oral devices to hold the lower jaw forward and open up the airway, or surgery. For more serious cases an electronic device can be implanted in the neck to stimulate the nerve that retracts the tongue in sleep. CPAP- is a device that prevents the airway from collapsing. A mask is strapped to the face of the patient and attacked is a small machine that pumps out air under pressure. The air that is being pumped from the machine opens up the airway more.

Question 20

v What is narcolepsy? How is it related to REM sleep?

Answer 20

• A desire to fall asleep in inappropriate circumstances/places. Sleep paralysis, hallucinations at the point of drifting off to sleep, as well as cataplexy (the sudden loss of postural tone). People with narcolepsy can flip into REM sleep early in the night. Multiple episodes of REM is a characteristic of narcolepsy. Without hypocretin, people with narcolepsy flip in and out of sleep and switch in and out of REM sleep. Hypocretin links directly to areas of the brainstem involved in the regulation of sleep and wakefulness as well as dreaming. Basically underperforming hypocretin can cause narcolepsy.

Question 21

What is hypocretin (aka orexin)’s role in narcolepsy? (Hint: Know results of the Stanford narcoleptic dog study – pages 117-118).

Answer 21

-Underperforming hypocretin can cause narcolepsy because hypocretin links directly to the areas of the brainstem involved in the regulation of sleep and wakefulness as well as dreaming.

Question 22

What is cataplexy? Why is it referred to as “weak with laughter?” Finally, what brain structures are involved in this phenomenon?

Answer 22

• Cataplexy is the sudden loss of postural tone. It is caused by strong emotion and laughter can be considered a strong emotion. Mild muscle weakness with laughter is a normal phenomenon. Hypocretin in the hypothalamus is very active when we experience strong emotions. However, with it underperforming it could cause the weakness in muscle tone. The amygdala is also involved. Circuits from the amygdala project to the areas of the brainstem involved in maintaining muscle activity. Where hypocretin is underperforming, it does not put the brakes on losing muscle tone.

Question 23

What particular genetic marker is most associated with the development of narcolepsy?

Answer 23

HLA DR2, which is a protein responsible for presenting fragments of infective agents to the white blood cells that combat infection.

Question 24

What does the flu have to do with the development of narcolepsy?

Answer 24

The flu virus strain itself can trigger narcolepsy and the Pandemrix vaccine. The H1N1 virus is very similar to bits of the hypocretin receptor, which can erode aspects of the hypocretin system.

Question 25

What are standard treatments for cataplexy?

Answer 25

• Antidepressant drugs. Boosting noradrenaline increases activity in the brain stem, which helps with the matintence of muscle tone. Sodium oxybate= reduces the amygdala’s response to emotional triggers.

Question 26

v Why do people without narcolepsy experience sleep paralysis and hypnagogic hallucinations?

Answer 26

• It could have to do with genetic factors, however sleep disruption is a common association. Examples= Shift work, night cramps, sleep apnoea and sleep quality in general all appear to increase the likelihood, as do certain psychiatric conditions such as PTSD and anxiety. These factors make it more likely for you to enter REM sleep very quickly, or they result in unstable sleep, and perhaps predisposes you to waking directly from REM.

Question 27

Why should the hallucinations that accompany sleep paralysis be so similar and universal? (Hint: Know the theory from V.S. Ramachandran – p. 191).

Answer 27

During sleep paralysis, people sometimes describe out of body experiences. Many of these symptoms can be argued as miscommunication between parts of the brain that represent where our bodies are in space. In normal life, motor areas of the brain send out signals to move our body, and these movement commands are monitored by the superior parietal lobule. But during sleep paralysis, there is no movement of the limbs, and no feedback about the changing position or movement of the body. This confusion gives rise to a failure to know where your body is in space. Ramachadran argues that the classic intruder hallucination is a projection of this little man and describing this neurological representation of the human body into our visual world, due to the disturbance of connections between the superior parietal lobule and motor and visual parts of the brain.

Question 28

What are the links between sleep paralysis and lucid dreaming?

Answer 28

Lucid dreaming is strongly associated with out of body experiences in sleep paralysis, rather than intruder or incubus hallucinations, leading some researchers to propose that these former phenomena are a feature of positive emotions associated with dreaming imagery, as opposed to the scary negative emotions of hallucinations involving strangers in the room or sexual assault. Basically both can be considered states during which greater or lesser degrees of REM sleep are intermixed with wakefulness.

Question 29

What is the Egyptian Dream Book? What types of information does it contain?

Answer 29

This book details 108 dreams, categorising them into good and bad, interpreting what these dreams predict. The ancient Egyptians believed that their gods could show themselves to us in dreams, and that dreams could also serve as a window into the netherworld.

Question 30

What and the world can babies be dreaming of? – Know Allan Hobson’s (Harvard Professor) answer to this question (p. 267).

Answer 30

According to the author, the answer is probably nothing or at least nothing like what we know of as dreams. It seems likely that our experience of dreaming, in the way we understand dreams, only really begins at an age when the brain is developed enough to represent subjective experience in a narrative way.

Question 31

Is REM sleep a facilitator of learning and memory?

Answer 31

Walker and his colleagues found that REM sleep helps us remember important things like recognising emotions expressed by faces, maze navigation, and creative thinking. In animal studies it has been found that REM sleep is prolonged after learning a new task, and that disruption of REM sleep also disrupts the learning process.

Question 32

How are REM sleep and cold temperature associated with one another?

Answer 32

During REM sleep our body temperature drops. However if we are too cold, we will not enter REM sleep. If you lose a lot of REM sleep it can actually cause your body temperature to have issues regulating. So with sleep deprived people, they may always feel cold in a room where everybody else feels hot. When we go into REM sleep its like fixing the system that regulates our body temperature and ultimately it will balance out in our waking life.

Question 33

How is REM sleep and PTSD related?

Answer 33

The traumatic experiences have generated such strong emotions, and the levels of noradrenaline are not fully suppressed, that these nightmares result in full awakenings. Each time the nightmare occurs, it is never completed, the emotions associated with that memory are not dampened down. The brain tries again and again to cleanse your memories of the fear of the emotional trauma associated with them.

Question 34

Define “overnight therapy” (p.275).

Answer 34

Basically in wakefulness your brain is flooded with various neurotransmitters, but when we sleep this changes. In NREM, levels of acetylcholine, serotonin, and noradrenaline fall away. However during REM sleep, acetylcholine spikes higher than seen in wakefulness. More research has shown that REM sleep can cause you to have less emotion of a memory compared to when you are awake. Basically your brain gets all the refreshing benefits while you are asleep.

Question 35

Know Hobson & Friston’s theory of how REM sleep is connected to “reverse learning” (p. 278).

Answer 35

REM sleep cleanses the neural networks of unnecessary connections formed throughout experiences during the day.

Question 36

How is hyperarousal associated with insomnia?

Answer 36

Hyperarousal is the jangling of nerves, the racing heart, being on full alert, the feeling of being excited or vigilant. When under stress, a number of neurotransmitters and hormones come into play. The state of being stressed or anxious leads to the boosting of a number of systems in the body, which results in higher levels of cortisol, adrenaline and noradrenaline. Basically the more stressed you are, it causes your body to increase more neurotransmitters which makes it harder for you to fall asleep.

Question 37

What does it mean to be an insomniac with “short sleep?”

Answer 37

Short sleep insomnia will take longer to drop off to sleep, and are much more vigilant while awake. For short sleep insomnia, they have heightened activity in the whole body, as demonstrated by chemical and physiological markers like heart rate. Basically because short sleep insomniacs have a hyperarousal state, it can be more threatening to them.

Question 38

How are sleep deprivation and insomnia different?

Answer 38

Insomnia is when you try to sleep but you can not fall asleep. Sleep deprivation is when you dont allow yourself enough time to sleep or restrict yourself from sleep.

Question 39

What are some of the drugs used to treat insomnia?

Answer 39

Sedating antidepressants, melatonin, antihistamines.

Question 40

What is CBTi? (p. 303)

Answer 40

CBTi is sleep restriction therapy. For insomniacs, some many associate their bed with anything other than sleeping such as thinking about the day or stressing over events. Sleep restriction therapy makes the patient stay out of their bedroom for as long as possible and then, when it’s time to sleep/ when they get super tired they can then enter their bedroom and drift off to sleep.

Question 41

What is the difference between dyssomnias and parasomnias?

Answer 41

Dyssomnias= Sleep itself is normal. But the client either sleeps too little or too much or at the wrong time. Could be caused by the timing of sleep or the quality.

Parasomnias= Something abnormal occurs during sleep, or during the times when the client is falling asleep or waking up. The quality, quantity, and timing of sleep are essentially normal.

Question 42

Know the dyssomnias including treatment options for each

Answer 42

Primary insomnia= Too little sleep. Vigorous daytime exercise, sexual intercourse, relaxation exercises, decrease stimulation and increase soothing environments such as ear plugs or calm reading, practice good sleep habits.

· Primary hypersomnia= Sleeping too much, as well as being drowsy at times when clients should be alert. Have healthy sleep habits, avoid alcohol and medications that may make you drowsy.

Question 43

What does insomnia look like in children? What are the two types?

Answer 43

Sleep onset Association= Prolonged night awakenings, child has learned to fall asleep with associations requiring parents.

Limit-setting subtype= Older children who resist going to bed. Verbal protests and repeated demands. They can cry and protest.

Question 44

What are characteristics of restless leg syndrome in children?

Answer 44

Urge to move legs usually accompanied by unpleasant sensation in legs. Occur exclusively or predominantly in the evening. The urge is relieved by movement. Children may have difficulty explaining this feeling.

Question 45

Know the parasomnias including treatment options for each

Answer 45

Nightmare disorder= Repeated awakenings from bad dreams. When awakened the client becomes oriented and alert. Some medications may help and therapy like psychotherapy (talk therapy).

· Sleep/Night Terror disorder= Abrupt awakenings from sleep, usually beginning with a panicky scream or cry. Intense far and signs of autonomic arousal. Reduce daytime stress, hypnosis, and relaxation therapy may help.

· Sleepwalking disorder = Rising from bed during sleep and walking about. Usually occurs early in the night. On awakening, the person has amnesia for the episode. Relaxation techniques, hypnosis, may need to sleep on the ground floor and have outside doors securely locked and have car keys unavailable.

Question 46

What is obstructive sleep apnea?

Answer 46

Excessive daytime sleepiness. Basically issues with the airway while you are sleeping which disrupts sleep patterns and causes you to wake up sometimes.

Question 47

What was Sigmund Freud’s early life like and how did it potentially impact his interpretation of dreams theory?

Answer 47

Freud had a close relationship with his mother, which could have impacted his interpretation of dreams theory. Also society was different back then, so his views on certain aspects could be frowned upon in today’s society.

Question 48

Who was Jean Martin Charcot and why was he important to Freud’s career?

Answer 48

Jean Martin Charcot is a French neurologist. He laid the foundation for Oliver Sacks. Believed in the psychological cause of symptoms and investigated hysteria. Started the diagnosis for MS and Parkinson’s Disease. Pioneered the art and science of medical photography. He was important to Freud’s career because he was the most influential neurologist in the 1800’s.

Question 49

Know the influences on Freud’s thinking

Answer 49

Zeitgeist- “spirit of the times”. Experimental psychology (search for elements of mind: Associationist philosophers, Method of introspection, measurement of sensation, Taxonomies of other sciences). Mystical Influence (more spiritual orthodox Jewish Background), Fruits of Materialism in Physics and Biology (Bernard’s concept of homeostasis, Helmholtz concept of the conversation of energy

Question 50

What is psychoanalysis? How is it cathartic?

Answer 50

Development of talk therapy, Method of “free association”. Slip of the tongue: Freudian slips (true personality coming out). Resistance. It is Cathartic because it means talking out and asking questions.

Question 51

What is free association?

Answer 51

Free association is a therapy method that takes one word, and you have to think of another word that comes to mind as quick as possible. It sees the persons mood and basically can see how they are feeling.

Question 52

Know characteristics of the id, ego, and superego

Answer 52

ID: source of instinctual energy (timeless, genetically defined, operates with the pleasure principle, primary process
Ego: cannot discriminate fantasy from reality, insures that ID is accommodated, uses Reality principle, secondary processes (learning, perception, memory), no moral values
Super Ego: Internalization of values of parents and society, Conscience: what leads to punishment, ego-ideal: what leads to good reward.

Question 53

What is psychosexual development?

Answer 53

Psycho: internalization of values regarding interpersonal relations.
Sexual: dealing with bodily pleasure
Early experiences with pleasure define the adult personality (embryological approach)
Erogenous development: pleasure derives not only from genital organs but from mouth and anus as well.

Question 54

What are the stages of psychosexual development?

Answer 54

Oral
Anal
Phallic
Latent
Genital

Question 55

Know examples of prototypes for the stages of psychosexual development and how these are related to the interpretation of dreams.

Answer 55

Oral: Taking in (acquisitiveness-fixation), Holding on (Tenacity-fixation), Biting (Destructiveness-fixation), Spitting out (rejection-reaction formation), Closing (Negativism-reaction formation).
Anal: Expulsive (Messy, dirty, extravagant- fixations), retentive (Frugal, compulsively cleaning-reaction formation).

Question 56

Oedipal vs. Electra Complex

Answer 56

Oedipal: Boys (desire to possess mother, jealous of father, fear of castration, renounces mother, identifies with father, turns towards other mother)
Electra: Girls (Desire to possess mother, notices lack of penis, feels castrated, blames mother, bad negative feelings towards mother, penis envy-failed men, prefers father, accepts hope of having a baby as substitute for penis.

Question 57

Dreams as wish-fulfillment

Answer 57

Wish-fulfillment: if you did not release your wishes during sleep, it can lead to psychological issues. Preserve sleep

Question 58

Manifest vs. latent content

Answer 58

Manifest content: dream as we experience it
Latent content: the repressed wishes