neurology

 

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The EEG during sleep

During the waking state, the EEG is characterized by low voltage, higher frequencies (> 30 Hz). As the person or animal goes into deeper and deeper sleep, slow waves become more prominent. Two particularly prevalent slow waves are delta waves and spindle waves. Delta waves are 0.5 to 4 Hz oscillations that are particularly prominent during deep sleep (stages 3 and 4). Spindle waves are 1-3 second duration epochs of "waxing" and "waning" 6-15 Hz oscillations. The occurrence of both delta waves and spindle waves are indicative of synchronized oscillations in thalamocortical systems.
 

Consciousness
  • An awareness of one’s own perceptions, thoughts, feelings, sensations, and external environment
  • Use when need to choose, difficult task, spotlight attention
  • Altered states – mental state other than ordinary waking consciousness

Sleep-Wake Cycle

  • As we age, we spend less time sleeping
  • First 6 months, may spend12-16 hours a day sleeping
    • 30-50% of that is in REM sleep
  • By 50-90 years, may only sleep 5-6 hours a day
    • 20% of that is in REM sleep

     

Falling Asleep - EEG
  • Beta waves
    • Alert state
    • Low amplitude, high frequency
  • Alpha waves
    • Drowsy, relaxed state
    • Low amplitude, slightly less frequent
  • Hypnagogic State
    • Between awake & asleep (Stage 1)
    • May experience:
      • sensation of falling
      • vivid visual images

       

Non-REM Stages of Sleep – slow breathing, heart rate, low blood pressure, brain activity at low point
  • Stage 1 Sleep
    • Theta waves
      • Slightly slower frequency, still low amplitude
    • Lightest sleep, easy to rouse
  • Stage 2 Sleep
    • Deeper level of sleep
    • More Theta waves
    • Sleep Spindles
      • Brief bursts of rapid brain activity
  • Stage 3 Sleep
    • Deeper sleep
    • Increase in Delta waves (20%)
      • High amplitude, low frequency
  • Stage 4 Sleep
    • "Deep sleep"
    • Delta waves (50%)
    • Difficult to rouse: confusion
    • This is when see bedwetting, sleep walking and talking, night terrors

     

Rapid Eye Movement (REM)
  • After 90 minutes of sleep, enter REM sleep.
  • Most dreaming occurs during REM sleep or more vivid dreams.
  • Also known as Paradoxical Sleep
    • Brain waves resemble stage 1(fast, low)
    • Harder to wake than when in stage 1 sleep.
    • REM paralysis - Muscles relaxed & inactive during REM sleep
    • autonomic nervous system is still active, eye movement, fast, irregular breathing and heart rate
  • REM rebound
    • Sleepers have longer periods of REM sleep after REM deprivation (alcohol, amphetamines, cocaine, LSD).

     

A Typical Night’s Sleep
  • Early in the sleep cycle:
    • More stage 3 and 4 sleep, less REM sleep (only 10-15 minutes)
  • Later in the sleep cycle:
    • More REM sleep (30-40 minutes), less stage 3 and 4 sleep (not even enter stage 4 after 2 cycles)
    • Each cycle approximately 60-90 minutes and get 5-6 cycles per night

     

Sleep Disorders
  • Insomnia
    • Most common
    • Difficulty falling asleep or staying asleep.
    • Type related to problem - depression, anxiety, drugs, etc.
  • Sleep Apnea
    • Stop breathing repeatedly while asleep, waken to begin breathing.
    • Associated with obesity, compression of windpipe
  • Narcolepsy
    • Sudden and uncontrollable onset of REM sleep from active, waking state (last 10-20 minutes)
    • Strong genetic component
  • REM sleep disorder
    • muscles may not become paralyzed
    • Sleeper acts out dream
    • NOT the same as sleep walking and sleep talking
  • Night terrors
    • Occurs in non-REM sleep (stage 4)
    • NOT a nightmare
    • panic attack while sleeping, may remain intensely afraid for a while

     

Why do we sleep?
  • Repair/Restoration theory
    • Sleep restores/replenishes us.
    • Fits with our feelings of tiredness if stay up for long periods of time.
    • Consequences of lack of sleep
      • May include: dizziness, poor concentration, irritability, tremors, hallucination.
  • Evolutionary (circadian) theory of sleep
    • Sleep forces us to conserve energy.
    • Also prevents us from harming ourselves or being harmed by predators.
    • Fits with us being tired at specific times

     

Dreams & Dreaming

·Dreams as Wish fulfillment (Freud)

  • Unconscious attempts to fill needs that can’t be expressed or that go unfulfilled.
    • Mostly sexual or aggressive.
  • Dream symbols disguise unacceptable wishes.
  • Manifest content
    • Apparent meaning e.g. gun
  • Latent content
    • Underlying or hidden meaning e.g. penis
·Reverse-Learning Theory
  • dreams are meaningless, just a way to rid us of unnecessary information accumulated during day. Housekeeping
·Off-Line or Dreams for Survival Theory
  • Disruption of REM sleep can interfere with learning and memory. Dreams are a way of thinking about and solving everyday problems. Problem focused
  • Ex. Sleep deprivation – see decreases in cognitive performance and function, increase in negative mode.
·Activation-Synthesis Theory
  • Dreams reflect effort of brain to give meaning to (random) neuronal activity occurring during REM. Dreams are meaningless
  • Example – Prefrontal cortex suppressed and emotional areas of brain as well as visual cortex activated. So bizarre events result from inability of brain to structure perception (the inhibitors are normally controlled by serotonin and noradrenaline in the daytime)

 

Hypnosis
  • State of altered attention and awareness
  • Not unconscious or asleep
  • Deep, focused, intense relaxation
  • Hypnotic suggestibility
    • Individual is receptive to suggestions to change behavior, perceptions, or thinking.
  • Hypnotic susceptibility
    • About 10% of population difficult to hypnotize, others highly suggestable, most of population falls inbetween
    • Hypnotically susceptible people:
      • Possess active imaginations
      • Have a tendency to fantasize
      • Demonstrate an ability to focus attention for long periods
      • Immerse themselves in imaginative activities
      • Process information quickly and easily

       

Elements for Induction:
  • Individual assumes comfortable position.
  • Not too comfortable!
  • Reduce visual & auditory distractions.
  • Focusing of attention - Object or imagined scene
  • Hypnotist makes suggestions consistent with individual’s experience:
    • "You’re feeling very tired"
    • "Your eyelids are getting heavy"
  • Gives credibility to hypnotist.

 

Hypnotic Phenomena
  • Pain perception
    • Hypnotically induced pain relief.
  • Hypermnesia
    • Enhanced recall of information? Pseudomemories - Some memories recalled under hypnosis may be inaccurate.
  • Posthypnotic suggestion
    • Suggestions for behaviors to be performed after hypnotic experience ends.
      • "When you crave a cigarette, you will think of how good it would feel to be a non-smoker"
  • Also used to treat high blood pressure, morning sickness, chemotherapy side effects

 

Myths
  • Can’t be forced to act against your will - can reject suggestion, particularly if go against morals
  • Hypnosis – depends on person hypnotized rather than hypnotist. Not everyone can be hypnotized (80-95% can - varies in depth of hypnotic state
  • Not stronger or more powerful - can see same behavior when not hypnotized
  • Not good at improving memories - pseudomemories
  • Not good at age regression - may act childish but may components similar to current (or at least older than age regression) age.

Nature of Hypnosis

  • Is hypnosis a truly altered state or merely an increased vulnerability to suggestion?
  • Hypnosis as an altered state
    • Dissociation
      • Part of consciousness separates or is split from consciousness.
    • Hidden Observer
      • Part of consciousness that remains aware
      • Not influenced by hypnotist
      • Hypnotized individuals report no pain but the hidden observer still experiences pain.
      • Suggests that hypnosis does induce an altered state.
    • Posthypnotic amnesia also supports this position.
  • Hypnosis as normal consciousness
    • Hidden observer reports different levels of pain perception depending upon hypnotist’s instructions
    • Age regression
      • Reenact or relive childhood events under hypnosis.
      • Experiences reported suggest individuals act as they think a child would act.
        • Drawings under hypnosis don’t have same characteristics as actual childhood drawings do.