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7 Sleep (Normal sleep (Measuring sleep (EMG (Extreme relaxation during…

- - - - 2
        
        Sleep spindles
        
        K-complexes
        
        10-25 minutes
      - 3
        
        Few minutes
        
        Delta waves
      - 1
        
        Does not always coincide with perceived sleep onset
        
        easily discontinued
        
        1-7 minutes
        
        Theta waves
      - 4
        
        Highest arousal threshold
        
        20-40 minutes
        
        Slow wave sleep #
        
        Delta
      - Inactive brain in movable body
    - - Characteristics
        
        Muscle atonia
        
        Episodic bursts of rapid eye movements
        
        Activated brain in paralyzed body
        
        EEG activation
        
        Beta waves
      - Abnormal entery into sleep (adults)
      - Hypnic myoclonia
        
        muscle contraction associated with vivid visual imagery
    - - alternation between REM and NREM
      - REM becomes longer across the night
      - time
        
        first cycle
        
        70-100 min
        
        90-120 min
  - - - still some info processing
      - Linking stimuli to punishment
      - Own name
  - - - electromyogram
      - gradual diminuation of muscle tonus
      - Extreme relaxation during REM
        
        recorded at chin
    - - slow, possible asynchronous eye movements
      - electrooculogram
      - Movement in REM
    - - Electroencephalogram
      - Bands
        
        Slow waves
        
        0-1 Hz
        
        Delta
        
        1-4 Hz
        
        Theta
        
        4-7 Hz
        
        stage 1 & 2 (?)
        
        alpha
        
        7-11 Hz
        
        Almost sleeping
        
        Sigma
        
        11-14 Hz
        
        Beta
        
        1
        
        14-20 Hz
        
        2
        
        20-35 Hz
        
        Gamma
        
        35-60 Hz
      - Measures
        
        PSG
        
        EMG, EOG, EEG
        
        Power spectral analyses
        
        Way to quantify the frequencies in EEG
    - - suggest hyperarousal
        
        greater N100
      - smaller N350 - less inhibtion
  - - - 1st year
        
        First stage is REM
        
        Faster cycle
      - Children
        
        More SWS
        
        Skip first REM
      - Older adults
        
        Less or no SWS
        
        Increased arousal
    - - low in morning
      - related to REM
- - - - pain
  - - - clinical history
        
        sleep diary
        
        Sleep efficiency lower than 85%
      - EEG
    - - Complaints
        
        sleep onset
        
        prolonged sleep latency
        
        30 min
        
        sleep maintenence
        
        difficulty maintaining sleep
        
        Awake for more than 30 min
        
        terminal insomnia
        
        Waking up too early
        
        Mixed insomnia
        
        different complaints
      - Cause
        
        Primary insomina
        
        not caused by other disorder
        
        causes distress and impairment
      - Duration
        
        acute
        
        less than 1 month
        
        Chronic
        
        more than 1 month
      - Subtypes
        
        Psychophysiological insomnia
        
        conditioning problem
        
        Sleep-state misperception/paradoxical insomnia
        
        50%
        
        gap between objective and subjective measures
        
        Idiopathic insomnia
        
        Starts from early childhood
        
        less emotional distress
    - - fatigue
      - Depression/anxiety
      - cogntitive function
        
        mixed results
        
        subtle deficits
        
        perceived sleep quality more important than subjective duration
      - More beta activity, less delta and alpha
        
        also during the day
    - - Neurocognitive model #
        
        Hyperarousal
        
        cognitive
        
        somatic
        
        conditioned cortical arousal from association of sleep related stimuli and encountered sleep difficulties
        
        enhanced sensory/information processing
        
        discepancies between subjective and objective ratings
      - Psychobiological model
        
        high levels of cortical arousal are not sufficient to explain insomnia
        
        Inability to de-arouse added to extra arousal
    - - reverse first night effect in insomnia
    - - discrepancies between objective PSG measures and subjective impression of sleep
      - People with insomnia...
        
        overestimate how long it takes to fall asleep and amount of times awake
        
        report greater benefits of medication than can be observed
        
        after waking up from PSG sleep patients report that they were awake
      - Explanations for paradoxes
        
        Psychological
        
        patients more prone to neuroticism and hypochondria
        
        also more prone to placebo
        
        does not explain
        
        how insomnia develops
        
        why sleep improves in some circomstances
        
        Why wakefullness is only described around sleep onset
        
        Behavioral
        
        Prone to insomnia due to traits
        
        acute insomnia
        
        maladaptive coping
        
        sub-chronic
        
        1 more item...
        
        biological factors
        
        hyperarousal
        
        Psychological factors
        
        worry
        
        social factors
        
        bed partner with incompatible sleep schedule
        
        social pressure to sleep
        
        Neurocognitive
        
        More gamma and beta
        
        form of conditioned arousal
        
        Increases around sleep onset
        
        Leads to increased
        
        sensory processing
        
        sleep difficulties
        
        diminished by hypnotics
        
        information porecessing
        
        perception of sleep and wakefulness
        
        diminished by information processing
        
        1 more item...
        
        formation of long term memory
        
        normally subjects cannot recall falling asleep
      - hypnotic medications do not normalise sleep architecture or
        produce a more sleep-like EEG
- - - - Negative effects
        
        suppress SWS
        
        tolerance, withdrawal syndrome
        
        but not addiction
        
        introduces a high frequency in sleep
        
        Interaction with alcohol
      - Binds to GABAa receptors
        
        increases CNS inhibitory effects
        
        Types
        
        GABAa
        
        Influenced by sedative-hypnotics
        
        GABAb
        
        spinal cord
        
        Enhance effect of GABA by binding on regulatory site
        
        activates channel more
        
        Increases Cl-
      - May be useful for acute insomnia
      - Why you can't kill yourself with them
        
        GABA dependent so always inhibit so inhibits itself
    - - can stop respiration #
      - Keep chlorine open without the presence of GABA
      - can lead to addiction
  - - - stimulus control instruction
        
        re associating bed wtimuli with sleep
      - Sleep restriction
        
        limiting time in bed to sleeping
    - - challenging dysfunctional beliefs about sleeping
    - - teaching about lifestyle