Sleep Flashcards
Sleep Stages
Stage 1: Wakefulness
Stage 2: Non-REM (1: transitioning = shallow sleep, important movements/easy to wake up, 3: the more and the higher the waves -> the deeper somebody is sleeping =deep sleep)
Stage 3: REM: dream, similar to the awake state, difference: no stimulation from the outside, rapid eye movement, no muscle tension
Sleep regulation: 2 Process Model
Process C
Circadian rhythm: 24 hours, stimulates one to be alert
during the day (fanfiar)
Process S
Sleep-wake dependent process: high sleep needs, sleep
pressure declines, increases until one sleeps, then
Decreases, homeostatic (hourglass)
-> combination of homeostatic and circadian regulation of sleep enables us to: sleep 8hrs at a stretch during the night, to stay awake and alert during the (16hr) day
Functions of sleep
- Physical health (recovery, no sleep: higher risk for weight increase/cardiovascular diseases/infections)
- Cognitive functioning (no sleep: worse executive functioning)
- Mental health
Chronic insomnia (chronification)/insomnia disorder
DEF Chronic insomnia:
- frequent & persistent sleep problems with daytime dysfunctioning
- the prevalence 4-10%
- residual symptoms: after remission depressive disorder insomnia continues in 40%,
Risk factors:
- Gender (risk: women)
- age (sleep quality decreases with age, less deep sleep)
- comorbid disorders
Dysfunctional beliefs: expectations, Worry/helplessness, consequences, medication
Physiological sleep changes with age
- Phase advance of the circadian system (tired earlier in the day)
- Shorter total sleep time (ca. 7h)
- Decreased deep sleep
- Decreased REM sleep
- Decreased sleep continuity
Possible Explanations for the high prevalence of insomnia in the elderly
.. in women
ELDERLY
- Normal age-related sleep changes
- Lifestyle
- Other sleep disorders
- Physical diseases
- Mental disorders
- Side effects of medication
WOMEN
- Sex difference in sensitivity/reporting symptoms
- Sex difference in help-seeking behavior
- Stronger fluctuations in reproductive hormones
- Higher prevalence of some sleep (RLS) and mental disorders
Interrelation between insomnia and mental disorders
- Study: people with insomnia -> much higher risk of developing depression, GAD, PTSD, and substance abuse
- Sleep signs first sign of mental disorder? Study: people not treated for insomnia -> a year later 20% developed a depressive episode -> insomnia treatment is preventative (for developing depression
- residual symptoms: after remission depressive disorder insomnia continues in 40%
- Insomnia + mental disorder: does insomnia have to be treated?
Study
Forensic psychiatric inpatients (but also healthy individuals): insomnia is correlated with subjective and objective aggression, CONCLUSION: poor sleep predicts an increase in aggression over one year period, poor sleep is generally associated with higher aggression - Study: sleep disorders exacerbate reduction in quality of life
- Study: insomnia inhibits recovery from depression
=> treat both
Explain how CBTs can be applied in the treatment and prevention of insomnia
Study:
- ICBT-i (internet CBT insomnia) is more effective than ICBT-d with respect to insomnia
- ICBT-i is as effective as ICBT-d concerning depression
=> insomnia is not merely a symptom of depression (or other mental disorders!), but needs separate treatment
CGT- i = CBT for insomnia, first choice of treatment (70% response, 30-40% remission)
- Components: sleep education, sleep hygiene rules, sleep restriction, stimulus control (the bed is only for sleeping, not worrying), cognitive therapy, relaxation therapy
- Interventions are effective, face to face is most effective, online intervention is cheaper
Sleep medication
Effects of benzodiazepines & Z-drugs
- shorten sleep latency (fall asleep quickly)
- improve sleep continuity
- promote N2, inhibit N3 & rem sleep -> promote light sleep, no deep or REM sleep -> “you are not awake”
- hangover effects
tolerance, dependency (physical and psychological) & rebound insomnia
- Use only for 2-3 weeks/use intermittently
- ‘Off-label’ prescription hypnotic psychopharmaca
- ‘Over-the-counter’ drugs/substances
Explain how insomnia may contribute to emotional distress/mental disorders
Restless REM-sleep in insomnia
- Sleep between healthy individuals and insomniacs is relatively similar, BUT in insomnia, there are more interruptions (awakenings) during REM sleep -> restless REM
Restless REM sleep and Emotion Regulation
=> REM sleep hypothesis of emotional brain processing: during REM sleep consolidation of emotional experiences and decoupling of affective tone, the affective load of the event gets decoupled/reduced
- Study: embarrassing karaoke, healthy vs insomniacs
CONCLUSION: Overnight worsening of emotional distress indicates maladaptive sleep in insomnia, good sleepers: shame decreases
Sleep medication
Over the counter drugs
Alcohol
- Insomnia risk factor alcohol abuse (OR=2) & relapse
- Effects first half of the night:
shorter sleep latency, increase deep sleep second half of the night: increase light sleep & wake & sweaty, high blood pressure, anxiety, nausea, …
- Withdrawal:
long-lasting problems falling and staying asleep, shorter sleep duration, … relapse
Melatonin
- Shorter sleep latency at low doeses (0.3-1 mg)
- Effective circadian rhythm sleep-wake disorders, such as DSPS, jetlag & shiftwork
- Effective sleep problems in children with ADHD / ASD
Cannabis (THC and CBD)
- Insomnia risk factor cannabis use (OR=2) & relapse
- Effects: unclear, possibly shorter sleep latency, decrease nightmares to PTSD (THC); tolerance & dependency; depending on dose, ratio THC/CBD, time of day & route administration
- Withdrawal: disturbed sleep, problems falling & staying asleep vivid dreams/nightmares, …
Cannabidiol
- Effects dose-dependent: low doses promote wake, higher doses (ca. 160 mg/day) may increase sleep duration & improve sleep continuity; low tolerance & dependency potential
