Chapter 5 Effects of sleep deprivation BY: DR. UCHE AMAEFUNA (MD).

THERE ARE MORE TO LECTURES THAN JUST SLIDES……..

Sleep deprivation may result in irritability, tiredness, confusion, lack of concentration, headaches, hallucinations and lack of energy.

Research has found that individuals who have been deprived of sleep are more able to concentrate on complex tasks than on simple tasks.

People do not need to sleep the same number of hours which they lost to recover from sleep deprivation.

When research subjects are constantly awoken when in REM sleep and are deprived of REM sleep over successive nights, they appear more tense, irritable and more anxious than subjects deprived of the same amount of sleep but not REM sleep.

Lack of REM sleep appears to affect our ability to concentrate and remember. When allowed to sleep uninterrupted, subjects experience REM rebound. That is, they spend twice as much time in REM sleep as normal to make up for the REM sleep lost. This indicates that REM sleep is vital for our survival.

Sleep disorders

Sleep clinics diagnose and treat many people who suffer from sleep disorders. We may identify with some characteristics of the following disorders however, a diagnosed sufferer would find the disorder debilitating, having an adverse impact on their life.

Insomnia: This is when a person has problems getting adequate sleep. This can be a temporary or chronic problem. It may be caused by stress, depression or changes in biological rhythms.

Hypersomnia: The person experiences excessive daytime sleepiness and has extreme difficulty in awakening. The person feels drowsy during the day no matter how many hours the person has slept. This may be caused by other sleep disorders such as insomnia, narcolepsy or sleep apnea.

Sleep apnea: This is a temporary cessation of breathing during the night (can be 20 seconds or more) which deprives the person of oxygen. It is associated with snoring where the person gulps for air then settles back to sleep. This may happen hundreds of times throughout the night and can be very dangerous to the person's health.

Narcolepsy: The person has sudden uncontrollable sleep attacks where they go from being wide awake straight into REM sleep.

The usual muscle paralysis of REM sleep occurs called cataplexy. This disorder can be very dangerous, especially if a sleep attack happens when the person is driving or working with machinery.

Sleep phenomena

Nightmares: These occur during REM sleep and are frightening REM dreams. They can usually be remembered and usually occur during a REM episode toward the end of the night or early morning.

Night terrors: These occur during NREM sleep (stage 4) and, because the muscles are not paralysed, they involve in violent body movements such as thrashing about or running.

The person often wakes up in a sweat and in extreme stress, unable to recall the night terror. Night terrors occur less frequently than nightmares and usually occur earlier in the night than nightmares.

Sleep walking: This occurs during the deep NREM sleep (stage 4) and hence it is difficult to wake the sleepwalker. It appears to be an inherited trait.

Sleep talking: This often accompanies sleep walking and also occurs during the deep stages of NREM sleep (stage 4). It is also thought to have a hereditary link.

Types of dreams

A daydream is an altered state of consciousness where there is a change in brain wave patterns. The person is awake and experiences thoughts, images and sensations that are usually positive and pleasant in nature.

The person has some control over daydreams and they have some positive effects such as: a way of relieving anxiety helping to keep mentally alert helping to solve problems increasing creativity

A night dream is also an altered state of consciousness. They may be positive or negative and usually people have little control over their contents.

Dreams in REM sleep tend to be more emotional and story-like in quality compared to dreaming in NREM sleep. NREM dreaming is more like thinking.

Lucid dreaming is when a person is aware that they are dreaming and is able to direct the action in the dream; the person has control over the sequence of events in the dream.

This has been used as a therapeutic technique where the dreamer attempts to change the negative ending of the dream to overcome a traumatic event.

States of consciousness This area of study focuses on states of consciousness and explores relationships between consciousness and thoughts, feelings and behaviour. It also examines the changes in the nervous system associated with different states of consciousness.

Definition of consciousness Consciousness refers to the level of awareness of our internal state and of our external environment.

It consists of the sensations, perceptions, memories and feelings that we are aware of at any given moment. Consciousness exists at different levels, from being in a coma (unconscious) to being fully alert and in a state of hyperactivity.

Consciousness also exists in a wide range of states. Depending on what we are doing, consciousness can be highly focused or more passive.

During a typical day, we experience many different states of consciousness from being very alert in an exam to feeling drowsy while travelling home on the train.

Streams of consciousness William James’s description of streams of consciousness.

William James ( ), an American psychologist, likened consciousness to a stream or river and called the mind a 'stream of consciousness'.

He saw consciousness as a stream that was continuous and ever flowing, not disjointed.

James believed that our thoughts, sensations, images and feelings are continually blending into each other, always changing and, like a stream, never ending.

Characteristics of normal waking consciousness. Internal and external focus…

Normal waking consciousness refers to the state of consciousness in which we are awake, alert and aware of our thoughts, feelings, sensations and our environment.

It is characterised by the following: Attention, memory, content and time limitations.

In normal waking consciousness our attention can shift from our internal thoughts and feelings to external stimuli, i.e. what is happening around us. These shifts of attention can be deliberate or they can occur without us being aware of it.

For example, if you were sitting on a train in a state of normal waking consciousness, your attention may be on your internal thoughts and feelings, thinking how tired you feel.

Your attention might then shift to external stimuli, the person entering the carriage. You might then focus on their appearance and where they choose to sit.

We cannot attend to everything that enters our senses. The amount of information that we attend to in normal waking consciousness at any one time is limited. We select only certain information and shift our focus and attention to information that interests or is meaningful to us.

In normal waking consciousness we have an awareness of our memories. We are conscious of past and present and can clearly differentiate between memories and what is happening to us at the present moment. We have a familiar sense of time and place.

High level and lower level awareness Playing a video game: high level awareness.

Levels of awareness within normal waking consciousness vary along a continuum between being alert, focused awareness and the minimal awareness characteristic of sleep. For example, at the alert end of the continuum are activities that demand high concentration, such as sitting for an exam or playing a video game.

Controlled processes This require alert awareness, full attention and they interfere with other ongoing activities. For example, when you are first learning how to drive a car, your full concentration and attention are required.

You would probably be so focused on changing gears, indicating correctly and watching your rearview mirror that you would not be able to pay much attention to the song playing on the radio. This focused attention is an example of controlled processes within normal waking consciousness.

Automatic processes In this processes, the driver is awake but on 'automatic pilot’ Once you have had some practice at driving, you will probably feel much more confident and no longer require such focused attention on the different aspects of driving a car.

Your consciousness then involves automatic processes. This is when you are awake but on 'automatic pilot'. Automatic processes occur with little awareness, require minimal attention and do not interfere with many other activities.

For example, after some experience driving a car, you would probably change gears or lanes without much effort or little awareness. You could then cope with changing radio stations while continuing to drive. Sometimes you may even wonder how you got to your destination as you weren't paying much attention to your driving.

Daydreaming Daydreams are another example of lowered awareness. Daydreaming involves drifting off into a world of fantasy. Although awake, the person experiences a reduced awareness of external stimuli.

Daydreaming usually occurs while the person is engaged in automatic processes where minimal attention to the task is required.

Daydreaming is often considered as a waste of time however, psychologists maintain that daydreaming can serve a variety of useful functions. It can help you relax, alleviate boredom and endure frustration.

Common characteristics of altered states of consciousness. Brain activity.

Common characteristics of altered states of consciousness and how these differ from normal waking consciousness: Altered states of consciousness are characterised by a change in brain wave patterns.

In an altered state of consciousness there are significant changes to the way people experience thoughts, feelings and sensations.

People are more likely to experience the extremes of sensations and emotions while in an altered state of consciousness. An altered state of consciousness may occur naturally, such as sleeping, or it may be intentionally induced, such as meditation.

In an altered state of consciousness most people report experiencing psychological changes. Some of these are: Perceptual and cognitive distortions: An altered state of consciousness can change the way we experience sensations. It can cause distortions in the meanings a person attributes to information entering the senses. This can result in distorted perceptions of external stimuli.

Thoughts can become disorganised, often illogical and lacking in sequence, as a result of an altered state of consciousness. A person in an altered state may also experience difficulties in solving problems, as information processing is often impaired.

The person's memory of events is not as efficient as in normal waking consciousness and they may be unable to recall certain events that took place while they were in an altered state.

Disturbed time sense An altered state of consciousness can change the way we experience emotions.

In an altered state of consciousness, our estimation of time can be inaccurate. Some people experience the feeling that the time has dragged on while others may feel that the time has zipped by.

Changes in emotional feeling and self-control An altered state of consciousness can also change the way we experience emotions. Some altered states, such as those brought on by certain drugs and alcohol, can cause a person to feel low, depressed or more emotional.

Many people find that they express their emotions more openly while under an altered state of consciousness compared to when they are in normal waking consciousness. They may also be more open to suggestibility and find that they behave without self control, acting in a way that they would not ordinarily act in normal waking consciousness.

Description of pain Meditations can take many forms. Whichever method is used, the aim is to modify psychological functions in order to control pain.

Some of the psychological changes resulting from meditation are: - An alteration in brain wave patterns showing more alpha waves - Less oxygen consumptions - Less Carbon dioxide exhaled - Less muscle tension - Lowered heart rate, blood pressure, and respiratory rate.

These physiological changes help the person achieve a sense of calm and well being. Meditation helps the person to focus on something else other than the pain and it helps to reduce the stress in the body. It serves as a beneficial non-medicinal pain reliever.

Biofeedback is where an individual is given external feedback about bodily functions such as blood pressure, pulse rate and muscle tension to bring an automatic physiological function under voluntary control.

The individual is wired to a machine which displays immediate feedback about physiological activity. The individual then learns how to change and control these physiological responses by using mental or physical means in response to the biofeedback.

Subjects can become so skilled at controlling bodily functions that they eventually do away with the biofeedback device and focus on the technique alone.

Biofeedback can be successfully used to treat migraines, asthma and other stress related illnesses. It gives the person some control over their bodily functions and, like meditation, helps the person to focus on something else other than the pain.

Some people choose to deal with and control pain using meditation. A description of pain as an altered state of consciousness: experiencing and controlling pain.

Extreme pain can cause a person to enter an altered state of consciousness where the individual's thoughts, feelings and sensations are different in some way to when they are in normal waking consciousness.

In order to deal with and control pain, some people use treatments which deliberately induce an altered state of consciousness such as meditation and biofeedback. Meditation is a deliberate attempt to bring on an altered state of consciousness in order to experience deep relaxation.

Meditation can take many forms, from concentrating one's attention on an external object or repeating a mantra to allowing the mind to be open and receptive to the surrounding environment.