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sleep disturbances Flashcards

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1
Q

what is sleep deprivation?

A

describes a state caused by inadequate sleep quantity or quality

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2
Q

what is partial sleep deprivation?

A

having less sleep that is normally required both in
- quantity: amount
- quality: how well we feel
quantity influences our perception of quality ➝ waking up several times (less quantity)= feel less rested (less quality)

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3
Q

what are the effects of partial sleep deprivation?

A

tend to be minor and temporary
- recover once sleep debt is paid

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4
Q

what is the effect of long term partial sleep deprivation

A

higher risk of a range of diseases, health problems, accident and injury
eg. diabetes, obesity, cardiovascular diseases

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5
Q

what is the effect of sleep deprivation on affective functioning?

A
  • less able to regulate and control our emotions
  • amplified emotional responses
  • decreased ability to process emotional info and make accurate perceptions
  • harder to judge others’ emotional responses
  • reduced emotional empathy
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6
Q

what is an amplified emotional response?

A

react quicker, more intensely and out of proportion to how we would normally react

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7
Q

what is the effect of partial sleep deprivation on behavioural functioning?

A
  • sleep inertia
  • slower reaction times
  • reduced motor control (clumsiness)
  • excessive sleepiness during waking time
  • fatigue (tiredness, lack of energy)
  • take longer to complete tasks
  • microsleeps
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8
Q

what is sleep inertia?

A

performance impairment that occurs immediately after awakening

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9
Q

what are microsleeps and how could they be potentially dangerous?

A

brief, involuntary period of sleep
- occur while we are awake
- less responsive to stimuli
- loss of awareness
- no recollection of what happened during microsleep

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10
Q

what are the effects of partial sleep deprivation on cognitive functioning?

A
  • irrational thinking
  • difficulty reasoning, making decisions
  • impairs learning & memory processes
  • difficulty paying attention
    ➝ lapses in selective attention and decreased ability to divide attention
    ➝ tasks may begin well but decrease as the duration of the task increases
  • increased errors especially for simple, monotonous, repetitive tasks
    ➝ can do well in complex tasks
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11
Q

what is a circadian rhythm phase disorder?

A
  • group of sleep disorders involving sleep disruption
  • primarily due to a mismatch between a person’s sleep-wake pattern and the pattern that is desired/required
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12
Q

what is sleep-wake shift in adolescence?

A

naturally occurring change in biological mechanisms regulating the sleep-wake cycle

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13
Q

what causes sleep-wake shift in adolescents?

A

biologically driven changes:
- hormonally induced shift of the sleep-wake cycle later by 1-2 hours due to melatonin secretion peaking later in the sleep-wake cycle= sleepier 1-2 hours later

psych & social influences:
- increasing independence
- increased demands on socialising
- increased academic & work demands

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14
Q

how does the sleep-wake shift in adolescents make them susceptible to circadian phase disorder

A
  • feel sleepier later @ night but must wake up early due to commitments (eg. school, work)
  • creates a mismatch between the sleep-wake cycle pattern & what is needed (9.25 hours)
  • accumulation of sleep debt across the week
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15
Q

what is sleep debt?

A

sleep that is owed and needs to be made up
➝difference between the amount of sleep needed to function effectively and the amount of sleep a person actually gets

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16
Q

what problems do sleep-wake shifts in adolescents cause?

A

high sleep disturbance impacts:
- daytime alertness
- functioning
- mood
- attention
= impacts schoolwork

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17
Q

what is shift work?

A

type of work schedule designed to meet the demands of a 24/7 society

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18
Q

how does shift work make someone more susceptible to circadian phase disorder?

A
  • The body is biologically programmed to sleep during the night and be alert during the day= difficult to adjust sleep-wake cycle due to changes in light exposure
  • Working at night may cause sleepiness and sleeping during the day can be interrupted/ poorer quality or quantity of sleep
  • mismatch between a person’s sleep-wake cycle and the sleep-wake schedule required by school, work or social schedule = makes circadian rhythms unstable/ more disturbances
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19
Q

what problems do shift workers experience?

A
  • difficult to sleep during the day= sleep 1-4 hours less than non-shift workers= sleep debt
  • difficulty with sleep onset + maintenance= poor quantity & quality sleep
  • shift work sleep disorder➝ excessive sleepiness on and off the job: insomnia when trying to sleep & excessive sleepiness when awake
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20
Q

what are ways to minimise the effects of shift work?

A
  • work on a particular shift for longer= more adjustment occurs as more time is available to ‘reset’ the sleep-wake cycle eg. 3 weeks instead of 3 day rotations
  • have successively later shifts rather than earlier ones due to sleep-wake cycle being closer to 25 hours eg. 7am-3pm shift ➝ 3pm-11pm shift not 11am-7am shift
    = less physio and psych disruption
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21
Q

what is jet lag?

A

sleep disorder due to a disturbance to the circadian rhythm due to rapid travel across multiple time zones

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22
Q

how does jet lag occur?

A
  • quick air travel= cycle is still aligned to the environmental time cues of home➝ not enough time to adjust to the new time cues in the external environment
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23
Q

how does jet lag make someone more susceptible to circadian phase disorder?

A
  • mismatch between a person’s sleep-wake cycle and the day-night cycle of their physical environment
  • biological clock is out of sync with the actual time in the time zone of the new environment
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24
Q

what problems does someone with jet lag experience?

A

• physical and psychological symptoms eg.
- difficulty initiating and maintaining sleep
- excessive sleepiness
- reduced daytime alertness
- impaired cognitive performance
- digestive problems
- malaise: bodily discomfort, loss of harmony from biological rhythms
• more arousal and NREM stage 1 sleep during the first few nights sleep
• second half of sleep cycle is more severely disrupted
• chronic long-term sleep disturbances for people who constantly fly

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25
Q

how are the effects of jet lag reduced naturally?

A
  • less time zones crosesed= shorter adjustment times
  • entrainment process: biological clock readjust a little but each day until aligned with the environment
  • phase delay: travelling west➝ follow the path of the sun (day is ‘longer’)= less mismatch between biological clock (which drifts towards 25 hours) and the day-night cycle
26
Q

why is travelling east worse?

A

phase advance: day is ‘shorter’= greater mismatch as it runs counter to the sleep-wake cycles tendency to drift towards 25 hours

27
Q

how can you minimise the effects of jet lag?

A
  • change eating and sleeping patterns in accordance with the ‘new time’ routines
  • use environmental cues eg.
    change time on watch, turn on lights to stimulate daytime or wear an eye mask to stimulate night time
  • when arriving spend time outside if it is daytime
28
Q

what is sleep disturbance?

A

any sleep-related problem that disrupts an individual’s normal sleep-wake cycle, including problems with sleep onset, waking from sleep and abnormal behaviour during sleep
- can be temporary, occasional or permanent

29
Q

what is a sleep disorder?

A

a sleep disturbance that regularly disrupts sleep, causing distress or impairment in everyday life during normal waking hours

30
Q

what is a primary sleep disorder?

A

a sleep disorder that cannot be attributed to another condition or use of a substance
eg. having insomnia and being regularly awakened during sleep because of it

31
Q

what is a secondary sleep disorder?

A

a prominent sleep problem that is a by-product of another condition or use of a substance
eg. experiencing regular awakenings during sleep due to back pain, anxiety or depression

32
Q

distinguish between dyssomnias and parasomnias

A

dyssomnias: involve problems with the sleep-wake cycle processes such as falling or staying asleep or a disruption to the timing of the circadian sleep-wake cycle
eg. sleep-onset insomnia

parasomnias: involve inappropriate disruptions of sleep by some abnormal sleep-related event
- not caused by dysfunction in any process that generates/times sleep
eg. sleep walking

33
Q

what are dyssomnias?

A

sleep disorders that produce difficulty initiating, maintaining and/or timing sleep
- people suffer from changes in the quantity or quality of their sleep and/or a problem with when they fall asleep

34
Q

what causes dyssomnias?

A
  • lifestyle factors
  • sleep environment conditions
  • naturally occurring changes and abnormalities
35
Q

what is sleep-onset insomnia?

A

sleep disorder involving persistent difficulty falling asleep at the usual sleeping time
- takes longer to fall asleep but can usually sleep throughout the night once sleep starts

36
Q

what are the symptoms of sleep-onset insomnia?

A
  • regular failure to fall asleep within 20-30mins after intention to go to sleep
  • complaint of poor quality sleep that is non-restorative/consistent reduced amount of total sleep
  • occurs as least 3x a week
  • experienced for at least 3 months
  • sleep difficulty occurs despite having the opportunity for adequate sleep
37
Q

what is the effect of sleep-onset insomnia on the sleep-wake cycle?

A
  • significantly disrupts the sleep-wake cycle and its regulation➝ changes in amount, restfulness and the timing or sleep
  • frustration and stress from lack of sleep= inability to fulfill daily commmitments= makes the problem worse
  • excessive attention and effort to sleep can override normal sleep-onset mechanisms
  • may result in delayed sleep phase disorder (sleep and awakening occur later)
    ➝ new problems with time-dependent requirements eg. school, work
38
Q

what are parasomnias?

A

characterised by the occurrence of inappropriate physiological and/or psychological activity during sleep or sleep-to-wake transitions
- unusual or abnormal behaviours

39
Q

what causes parasomnias?

A

usually result from inappropriate activation of the CNS (transmitted through the ANS or skeletal muscles) or failure of neural processes
- stress, anxiety, emotional events and certain medications

40
Q

what is sleep walking?

A

involves getting up from bed and walking about or performing other behaviours while asleep
- commonly routine activities of low complexity
- usually end spontaneously if the person is left alone
- generally eyes are open but ‘blank’
- movements are often clumsy, but can maintain coordination
- risk of self-injury
- generally occurs during NREM 3 & 4 (no sleep paralysis)= disorientated when awoken

41
Q

what is the cause of sleep walking?

A
  • neurological basis is unclear
  • brain is partially aroused like in a waking state to complete behavioural activities but partially in deep sleep (no conscious awareness)
  • common triggers= stress, anxiety, emotional events, certain medications, genetics, medical conditions
42
Q

how do you treat sleep walking?

A

no specific treatment
- keep sleep environment safe
- improve sleep habits

43
Q

what is the effect of sleep walking on the sleep-wake cycle

A
  • may not be able to go back to sleep quickly ➝ sleep episode is fragmented= loss of deep sleep= sleep is not as restful= tiredness during the day
  • poorer concentration
44
Q

what is the main assumption? (CBT)

A
  • assumes the way people think affects how they feel and behave
  • Thus, by changing the way people think (about a phobic stimulus) it can change the way people
    feel and behave.
45
Q

how does cognitive behavioural therapy work?

A
  • structured, short-term program focused on the present: current thoughts, feelings and behaviours
  • explain cognitive component, behavioural, aim of CBT
46
Q

what is the goal for cognitive behavioural therapy for insomnia (cbt-i)

A

identifying and changing negative thoughts and inappropriate behaviours about insomnia and sleep with more balanced and realistic ones
- people must understand the difference between thoughts, feelings and behaviours, their inter-relationship and relevance to sleep and insomnia
➝ undertake sleep education sessions and keeps a sleep diary

47
Q

how does the cognitive component of cognitive behavioural therapy (cbt) work?

A

helps the person recognise and change inappropriate/dysfunctional attitudes, beliefs and thoughts about their sleep
= gives a more positive and realistic appraisal
= less pressure to fall asleep and less physio/psycho arousal
= may promote sleep

48
Q

what is the cognitive component of cognitive behavioural therapy for insomnia?

A
  • learn to control negative thoughts that prevent sleep onset
  • addresses anxiety about sleep difficulty
  • after identifying these thought patterns, alternative ways of thinking are explained so the person can think differently about their insomnia
49
Q

what is the behavioural component of cognitive behavioural therapy (cbt)

A

involves the individua; developing good sleep habits and avoiding behaviours that prevent them from sleeping well
eg.
- stimulus control therapy
- sleep hygiene education

50
Q

what is stimulus control therapy and how does it work?

A

learning to overcome learned associations acquired by people with insomnia and lead them to form new associations
- bed/room becomes associated with behaviours not compatible with sleep= overtime more difficult to sleep
- aims to strengthen bed/rooom as cues for sleep and weaken cues for non-sleeping behaviours + establish a regular sleep-wake cycle

51
Q

what is sleep hygiene and how does it work?

A

practices that tend to be highly effective in the treatment of insomnia to help establish and maintain a regular sleep-wake pattern
eg. make sure you explain why
- establish a regular relaxing sleep schedule and bedtime routine
- associate your bed/room with sleep
- if you can’t sleep get out of bed
- exercise early
- ensure adequate exposure to natural light

52
Q

what sleep habits should you avoid?

A

explain why
- napping during the day
- stimulants
- stimulating activities
- alcohol
- large meals before bedtime

53
Q

what is the aim of bright light therapy?

A

resets the biological clock using light to regulate a person’s sleep-wake cycle to align it with the sleep-wake cycle they need or require

54
Q

how does bright light therapy work?

A
  • exposure of the eyes at the required time of the day with the right (high) intensity light for the right duration
  • light is received by the eyes for transmission to the SCN to influence the decrease release of melatonin from the pineal gland
  • sleep-wake cycle is gradually changed
  • regular sleep patterns help the clock stay ‘set’ at the new time
55
Q

what is delayed sleep phase disorder and how is it a desynchronised phase shift?

A

adolescents and others who feel sleepier later than desired
- later shift in the morning disrupts daytime commitments

56
Q

how does the timing of bright light therapy re-shift the sleep-wake cycle in delayed sleep phase disorder?

A

light exposure occurs early in the morning to shift the sleep phase forward
= person is sleepier earlier
= wake up earlier

57
Q

what is advanced sleep disorder?

A

people feel sleepier earlier at night than normal + wake up earlier than desired
- usually elderly

58
Q

how does the timing of bright light therapy re-shift the sleep-wake cycle in advanced sleep disorder?

A

light exposure occurs in the evening to shift the sleep phase back
= sleep occurs later
= wake up later

59
Q

how does the timing of bright light therapy re-shift the sleep-wake cycle in shift workers?

A
  • light treatment in the evening/before shift starts
    = more awake and alert during the night as melatonin release from the pineal gland will be delayed
60
Q

how does the timing of bright light therapy re-shift the sleep-wake cycle in jet lagged people?

A

eastward travel: morning light therapy at destination to advance the sleep-wake cycle
= fall asleep earlier
= wake up earlier
westward travel: evening light therapy to delay sleep-wake cycle
= fall asleep later
= wake up later

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