sleep disturbances Flashcards
what is sleep deprivation?
describes a state caused by inadequate sleep quantity or quality
what is partial sleep deprivation?
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)
what are the effects of partial sleep deprivation?
tend to be minor and temporary
- recover once sleep debt is paid
what is the effect of long term partial sleep deprivation
higher risk of a range of diseases, health problems, accident and injury
eg. diabetes, obesity, cardiovascular diseases
what is the effect of sleep deprivation on affective functioning?
- 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
what is an amplified emotional response?
react quicker, more intensely and out of proportion to how we would normally react
what is the effect of partial sleep deprivation on behavioural functioning?
- 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
what is sleep inertia?
performance impairment that occurs immediately after awakening
what are microsleeps and how could they be potentially dangerous?
brief, involuntary period of sleep
- occur while we are awake
- less responsive to stimuli
- loss of awareness
- no recollection of what happened during microsleep
what are the effects of partial sleep deprivation on cognitive functioning?
- 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
what is a circadian rhythm phase disorder?
- 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
what is sleep-wake shift in adolescence?
naturally occurring change in biological mechanisms regulating the sleep-wake cycle
what causes sleep-wake shift in adolescents?
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
how does the sleep-wake shift in adolescents make them susceptible to circadian phase disorder
- 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
what is sleep debt?
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
what problems do sleep-wake shifts in adolescents cause?
high sleep disturbance impacts:
- daytime alertness
- functioning
- mood
- attention
= impacts schoolwork
what is shift work?
type of work schedule designed to meet the demands of a 24/7 society
how does shift work make someone more susceptible to circadian phase disorder?
- 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
what problems do shift workers experience?
- 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
what are ways to minimise the effects of shift work?
- 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
what is jet lag?
sleep disorder due to a disturbance to the circadian rhythm due to rapid travel across multiple time zones
how does jet lag occur?
- 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
how does jet lag make someone more susceptible to circadian phase disorder?
- 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
what problems does someone with jet lag experience?
• 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
how are the effects of jet lag reduced naturally?
- 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
why is travelling east worse?
phase advance: day is ‘shorter’= greater mismatch as it runs counter to the sleep-wake cycles tendency to drift towards 25 hours
how can you minimise the effects of jet lag?
- 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
what is sleep disturbance?
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
what is a sleep disorder?
a sleep disturbance that regularly disrupts sleep, causing distress or impairment in everyday life during normal waking hours
what is a primary sleep disorder?
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
what is a secondary sleep disorder?
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
distinguish between dyssomnias and parasomnias
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
what are dyssomnias?
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
what causes dyssomnias?
- lifestyle factors
- sleep environment conditions
- naturally occurring changes and abnormalities
what is sleep-onset insomnia?
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
what are the symptoms of sleep-onset insomnia?
- 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
what is the effect of sleep-onset insomnia on the sleep-wake cycle?
- 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
what are parasomnias?
characterised by the occurrence of inappropriate physiological and/or psychological activity during sleep or sleep-to-wake transitions
- unusual or abnormal behaviours
what causes parasomnias?
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
what is sleep walking?
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
what is the cause of sleep walking?
- 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
how do you treat sleep walking?
no specific treatment
- keep sleep environment safe
- improve sleep habits
what is the effect of sleep walking on the sleep-wake cycle
- 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
what is the main assumption? (CBT)
- 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.
how does cognitive behavioural therapy work?
- structured, short-term program focused on the present: current thoughts, feelings and behaviours
- explain cognitive component, behavioural, aim of CBT
what is the goal for cognitive behavioural therapy for insomnia (cbt-i)
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
how does the cognitive component of cognitive behavioural therapy (cbt) work?
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
what is the cognitive component of cognitive behavioural therapy for insomnia?
- 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
what is the behavioural component of cognitive behavioural therapy (cbt)
involves the individua; developing good sleep habits and avoiding behaviours that prevent them from sleeping well
eg.
- stimulus control therapy
- sleep hygiene education
what is stimulus control therapy and how does it work?
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
what is sleep hygiene and how does it work?
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
what sleep habits should you avoid?
explain why
- napping during the day
- stimulants
- stimulating activities
- alcohol
- large meals before bedtime
what is the aim of bright light therapy?
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
how does bright light therapy work?
- 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
what is delayed sleep phase disorder and how is it a desynchronised phase shift?
adolescents and others who feel sleepier later than desired
- later shift in the morning disrupts daytime commitments
how does the timing of bright light therapy re-shift the sleep-wake cycle in delayed sleep phase disorder?
light exposure occurs early in the morning to shift the sleep phase forward
= person is sleepier earlier
= wake up earlier
what is advanced sleep disorder?
people feel sleepier earlier at night than normal + wake up earlier than desired
- usually elderly
how does the timing of bright light therapy re-shift the sleep-wake cycle in advanced sleep disorder?
light exposure occurs in the evening to shift the sleep phase back
= sleep occurs later
= wake up later
how does the timing of bright light therapy re-shift the sleep-wake cycle in shift workers?
- 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
how does the timing of bright light therapy re-shift the sleep-wake cycle in jet lagged people?
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
