Saturday 3 January 2015

Emotions and Emotional Avoidance



Emotional Avoidance and its therapeutic impact
Contents
Introduction. 1
Emotion. 1
Moods. 3
Pitstop. 4
Emotional Avoidance. 4
Client Impact. 5
Emotional Processing. 6
The sequence of the system of Emotion. 7
Emotions that hang around. 7


Introduction

What I am going to do here is state what an emotion is and delineate it from a mood. Then we are going to look at the levels of emotional avoidance and then we are going to look at its therapeutic impact, how does that sound, have I missed anything??

Emotion

What is an emotion, well a lot has been written about it. My take derived from what I have read and experienced is this:
Emotions are the names of congruent systems within humans whose nexus is that something is currently important\significant which has an impetus to action. Emotions can be understood as on a continuum of intensity.  Low intensity means a weaker congruence of the various systems, and a weaker urgency to act. Higher intensity is a stronger congruence and a stronger urgency to act.
Whilst it might be said that emotions are prototypical. That is to define an emotion is to compare it against a prototypical example of it, most emotional states are mixes of different emotions.
The main aspect of an emotion, its nexus is that something is of significance to the person having the emotion.  As soon as something is understood to be significant, then the rest of the complex can become instantiated. Below there is an example of an emotion as it spans across the variety of human systems, the style mentioned for these systems, is the congruent style, for the type of significance. So sadness, the style is something I value has been taken away. Anger that a rule I value has been broken.
What then are the human systems that become congruent in an emotional state?
1.       Affect, i.e. feeling
2.       Cognitive
3.       Motivational
4.       Behavioural
5.       Perceptual
6.       Memory
7.       Imaginal
8.       Physiological

 If I am anxious, I believe there is a threat to something I value. So I may think of all the other times I have not been able to protect myself from important things being taken away, I may be motivated to retreat to a safe place, or to call for support to protect what I value. Behaviourally I may fight\flight or freeze.  I perceive the scene in front of me in terms of the emotion that I feel. So in anxiety then the escape routes and the threats will all be more pronounced. My memory, will have a bias to previous events that are related to anxiety. My memory will associate the atmosphere of the situation in relation to previously anxious situation, e.g. the smallness of the room. Imagination will imagine anxiety based scenarios played out, to establish the action that motivation calls me forth to do.
So in summary, when something is immediately of importance to us, or significant to us, then we have an emotional state, this prompts us quickly to action and aligns all aspects of our being into this action. Of course the stronger the emotion, the greater the congruence, the greater the number of systems that are involved.
Now it can be reasonable to say that not all of these components need to be present to call something an emotional episode. If your child broke a window, you might at the time it happened feel anger, but later in the day, when the feeling has subsided, say to them, “I won’t give you any money to go out as I’m still angry with you”.  It could be argued that you are still are in the state of anger with them, but there is no affect. What this does is to highlight the difference between the episodic nature of an emotion versus its state based aspect.
An episode is fleeting, for instance the feeling of love. Then there is the state of being in love, where you may not feel love all the time to your partner, but you generally act with styles that reflect this, in some way this is your nexus. Of course over and above that are moods that we will come on to in a moment. Before we do, just to summarise by way of example the various aspects of emotion:
So if you feel fear in the face of a pack of wolves:
1.       Type of appraisal
a.       Judgement that something I value will be taken away, i.e. my life
2.       Affect
a.       Fear
3.       Cognitive style
a.       One that will understand the situation in terms of fear, and how I can escape the feared object.
4.       Motivation
a.       The desire to act will be on the fight, flight or freeze register, dependent on the combination of appraisal of the situation and memories of past events, related to the current one
5.       Behavioural style
a.       Here the behaviour will depend on the results of the motivation, but running, hiding, fighting will here be the order of the day. Of course whilst deliberation is happening the behaviour might well be to reduce the attack surface, to cower or hide until the decision has been made
6.       Perceptual style
a.       How the scene in front of you is perceived will be in terms of the possibilities of level of danger, means of escape, allies that we can call on, instruments we can use to defend us, indicators of the ferocity of the wolves.
7.       Memory style
a.       What may be called up to inform our current scene is times I have dealt with associated items before, fear, wolves etc.
8.       Imaginal style
a.       Again whilst I perceive the current scene in terms of fear, I can play out in imagination, likely scenarios to see which one would be the best to take.
Thus to define emotion would be the state a human is in when something is currently significant to them, where there is congruence of their various systems and there is a call to act.
 To talk about emotions in this way, whilst it seems to have worth to be analytic about them, and to be able to see their components, is however abstract.  To have the emotion of fear in the face of a pack of wolves, is to already presuppose I find myself situated in a scene, containing me and the world, and the world containing wolves. It is already to presuppose myself in a matrix of projects, I was walking in the woods, to soothe my head after a hectic day at work. My job being something I do for a variety of reasons. It could then be argued that whilst the predominant emotion would be fear, actually when we site any scene within the matrix of projects, then we take along our mood, what then do we mean by mood?

Moods

If I could define a mood as a general way of being open to the world. So similar to an emotion but happening over a long period. Thus you may describe someone as in an irritable mood as things generally draw them to irritation, or optimistic as they have a tendency to be drawn to hope.
Whilst I’m not sure a hierarchy is possible, moods seem entwined with projects that we have. The projects can be a determinate task, fix the car, or a value of career success, or a role of being a father, at any time a person will no doubt be in the throw of many projects all with different types of orientation to.
It is from the projects, the things that I care about, that the background is set to the unfortunate situation where I meet the pack of wolves. The mood I am in is the style of situatedness I have, my deportment to the world. It is prior to the perception that I have of the wolves, and indeed explains the perceptual bias I have, as I first see them. This perceptual bias, is the perceptual congruence we have to mood\emotion, where in states of anxiety we have a perceptual bias to see things we could be anxious about, and means to deal with them. Indeed it could well be argued, that it’s not just a perceptual bias of a pre-existing objective world, the world of the scientist devoid of bias, but rather, our world is the world of perceptual bias, as yours is of yours.
As we talk about mood, this can either be an emotional hue, e.g. anxious or depressed, or it can be more purposive and rational, or more rational and philosophic, a mood, then is a general disposition to engage in a certain way with the world, that is the container in which an emotion appears.  Whilst it might be a chicken and egg thought but there is a relationship between the collective hue of the style of your current projects and your current mood.
It could also be argued that your current mood is defined out of the impact of your relation to your various projects and the weighting each of those projects has to your current mood is dependent on your emotional engagement to those projects, and how recent. Thus if you had been very angry as a father and about how others were treating your child, then this my start to generate a theme of injustice within your mood.
There seem other constituents to mood apart from your project engagements:
Somatic input and societal
On a somatic level, so sleep levels, sexual satiety, fitness levels, your relationship with food, drink and drugs.
On a societal level there can be emergent themes, as we are generally in the grip of austerity, or your firm is doing very well, or there are many burglaries in the neighbourhood, then these things as well will contribute to your mood.
As moods last over longer times, then they span emotional episodes, so coming out of that can be certain mood styles, where you may get quick movement between emotions, or very intense emotions, or indeed very strong reactions when certain emotions are felt.
In terms of sequence then in the complex of your current projects and mood, you perceive the world and your relationship with it and within that can experience emotion. Dependent on your engagement with the world and the development of your projects so your mood and perceptions change.  

Pitstop

Just before we move on it might be worth introducing a third term for emotions, that of state.
So we can have an occurrent emotion, we feel fear in front of a wolf. We can also said to be afraid of wolves, so I have an emotional relationship to wolves, such that when I see them, I feel fear. This may help the sense of the emotional state of love, which doesn’t depend on feeling love all the time when in the presence of your partner.

Emotional Avoidance

To talk of emotional avoidance is to talk of avoiding what is of significant to you, what you care about in the world that calls you to action.
So what can we give as examples of emotional avoidance? Well there can be the immediate sense of an emotion being replaced with something else. This something else can be emotional, behavioural or cognitive.
Emotionally, when someone is hurt they might quickly feel anger and ignore the hurt. If someone feels angry they might quickly start cleaning the house to take their experience away from the anger.
Behaviourally someone might feel shame, but quickly make a joke out of it, to reduce the engagement they have with shame. Likewise there may be an emptiness of feeling, where the effect of shame is not acknowledge or paid attention to.
Cognitively someone might feel excitement, they might intellectualise so as to reduce their joy.
As much as emotions felt can be replaced with something, there can also be the case that emotions can be avoided, through avoiding triggering situations.  This can be done to structure your world such that you attempt to avoid a certain feeling, you try to stay in control at all times to avoid feeling fear.   You may avoid people who have strong emotions, avoid thinking about something that happened in a certain way. So the death of your father, you might not think about the loving relationship that is now lost, but rather you may think about the times that he let you down so that you can mitigate the feeling of loss.
Our engagement with the world through perception, memory and imagination, which would seem like a perceptual engagement with past, present and future, can also be engaged in, in an emotionally avoidant fashion.
Memory can you be used so you might only remember certain aspects of an event or person to diminish their feelings.
Perception can be, well I would argue always is biased, and this bias can be to avoid the emotionally provoking aspects of a scene.
In imagination likewise the future can be rolled out in an emotionally muted fashion.
It can also be argued that people can find certain emotions or maybe a range of emotions incredibly unpleasant to deal with. Instead of feeling them, then some form of escape route is taken, this can be through anything that provokes another feeling, so drink, drugs, shopping, sex, career success, can all be things that can be used to manage unpleasant emotions. Of course, the only way to tell if this is the case, would be to do a functional analysis of the person’s behaviour in question.
Three other strategies of emotional avoidance are
1.       Avoidance
2.       Disassociating
3.       Worrying
Firstly there can be avoidance of situations that provoke an unpleasant feeling, or escape from a situation where there is the experience of an unpleasant emotion, for instance anxiety.
Secondly there is disassociation where you can see yourself in a situation rather than experience directly.  Dissociation ranges on a continuum from detaching yourself from a boring situation, which gives yourself a feeling of not being there, of being in your own bubble to dissociative disorder where you dissociate to the point of amnesia, or dissociate from your way of being to another, as in multiple personality disorder.
Thirdly worrying can be a way to reduce the emotional effect of a memory, or perception.
You might also wonder whether the dominant mood could have an impact on emotional avoidance, if someone mood is very intellectual then this would mean to predominantly engage intellectually, or if someone was in a grumpy mood, then they might other emotions that weren’t grumpy ones.

Client Impact

So if a client is emotionally avoidant what does this mean? Well firstly I guess we need to state how avoidant? Of one emotion, of all emotions? Let’s put it on a scale from one to all emotions, and I guess people who are avoidant of all emotions are practically zero.
Let’s say that the core of emotions is that they tell me about something of value to me, something that I care about is present and it could be a threat to that, that it might be taken away or it could be that I am going to gain it, and that I am called to action.
So whilst a fully emotionally avoidant person is an unlikely client to have, what does it mean if someone looks to avoid experiencing certain emotions?
Well firstly they can’t get to realise that there is something that is of value to them that action needs to be taken about. They also can’t get to find out if the emotion which contains a judgement is a sound judgement and also if they are willing to act in the way that their emotion directs. Indeed if the latter were frequently the case, then it is unlikely the emotion would be felt. No prompt to action would be issued as no action is taken. Thus there is the sense that the client is not going to understand their world, and what is important to them as much as they could. They are restricted, their vision limited.
Given there is a call to action from emotions, then for a client to avoid certain emotions, is then to lose spontaneity in that situation and to not be in a certain type of relationship within the world. So if a client eschews anger, then when a situation that calls forth anger, then spontaneity is lost, and the authentic relationship the client has with the world is lost.
We must however distinguish two different aspects of emotion, that that turns up in an emotional episode and that that turns up via a mood. If we talk about anxiety as a mood and anxiety as an emotion, then the anxiety of mood construct the situation in which the emotion is then felt.  Here you have the phenomena of how the situation is set up anxiously and then the anxiety that it provokes is turned away from.  But again the irony in that there is only something to be anxious about because of the anxious moods construction of the world as such. The left hand creates the world, the right hand looks away.

Emotional Processing

If we understand the affect within the emotional complex to be the call to immediate action, then there are several ways that we can respond to it.
1.       We can act as if it’s true
2.       We can avoid it
3.       We can experience it and understand it
In the first instance we can act as if it’s true. Emotions contain a cognitive appraisal, so there is a sense in which an emotion can be true and false.  If I feel anxiety because I know there is a hungry tiger at my door, then this would be a true appraisal.  If however I have a high level of fear as an adult in the face a house spider then we would say the appraisal in the emotion is false.  In both of those situation there is a call to fight or flight, although actually it would seem more useful in the latter case, to experience the emotion, to discover the appraisal is false.  Sometimes then to act on your emotions is to deny yourself finding out they are not true. However not to act on an emotion with a true appraisal could be costly, especially in the case of the hungry tiger.
In the second instance we can avoid the emotion This can be by any of the mechanisms noted above. So we can focus our attention away from it, or use a cognitive, behavioural, physiological or emotional strategy to take our attention of it.  Here we fail to find out what is potentially significant about what happened for us. Moreover we are failing to find out, if the emotion is actually true.  For instance, we may be hurt by something someone said, and our avoidant strategy is immediately get angry and cover the hurt. It could be when we look at why we feel hurt that this contains an archaic interpretation of events that doesn’t still suit us.
In the third event aspect we can experience the emotion, not act on it, but sit with it and understand it. This may reveal propositional statements about ourselves\the world\others which may not be true, or may not suit us anymore. It may reveal prior emotions that we didn’t realise we felt, above all it can show us cognitively our values, which may have slipped away from us.

The sequence of the system of Emotion

You may well notice the sequence of the emotional complex.
We perceive a scene, biased by the emotion that we are in.  The emotional hue is tempered by our association with our memories, and the thrust of our projects via our imagination.
Within this perceptual horizon we focus on a specific aspect of it, we think about it in a certain way, which in turn has an emotional and physiological impact. On the basis of the emotional call to action, then behaviour can ensue, which can play out the emotion. In anger the wrong righted, in anxiety the fear avoided, in joy the sublime scene enjoyed, in sadness tears cried.
Thus from initial perception to behavioural response, the emotion is instantiated, then discharged. Of course there are an infinite number of variants in this, with emotions\physiological responses being events that create other sequences, but in its simplest form we have the above.
This seems useful to point out, as many theorist consider the expression of emotion to part of the emotion, but it seems more that than, it seems the end of an emotional episode, and conceivably the start of a new one.

Emotions that hang around

As emotions are calls to actions, then we have 3 choices, act, ignore or dispute. In action we end the emotional episode and bring a new one. If we deny we hear the call to action of the emotion, and we dispute the validity of it, or it’s utility. I may feel fear as I speak to a lecture hall of students, but I think there is no need for me to, so I will notice the fear that I am feeling and carry on regardless.
If I don’t discharge the emotion, then it will be associated with the memory of that event, it will be more likely to be recalled by association. So if I was in a car crash and I haven’t processed the emotions from it, then when I see a car brake suddenly I can be reminded of my accident and I can relive the scene with the original emotion that was attached to the memory.


Counting Sheep by Paul Martin



Counting Sheep by Paul Martin
Contents
Introduction. 2
Chapter 1: A Third of Life. 2
Chapter 2: Sleepy People. 3
Chapter 3 Dead Tired. 3
Chapter 4 The Golden Chain. 4
Chapter 5 The Shape of sleep. 4
The sleep cycle. 5
REM sleep. 5
The Sleep cycle continued. 5
Waking up. 6
Quality of sleep. 6
Chapter 6: Morpheus Undressed. 6
Larks and Owls. 7
Chapter 7 Strange tales of Erections and yawning. 7
Chapter 8 Friends and enemies of sleep. 7
Things that affect sleep. 7
Caffeine: 7
Alcohol 7
Tobacco. 8
Food. 8
Exercise. 8
Noise. 8
Shift Work. 8
Hypnotics. 8
Chapter 9: Dreams. 8
Chapter 10 A Second Life. 9
Chapter 11 from Egg to Grave. 10
Chapter 12 The Reason for sleep. 10
What is sleep for. 10
What is REM sleep for?. 10
Chapter 13 Bad Sleepers. 11
Why can’t you sleep. 11
What to do to help sleep. 12
Treatment. 12
What to do to stay awake. 12
Chapter 14 Dark Night. 12
Moving Sleep. 13
Sleep and guts. 13
Troubled minds. 13
Sudden nocturnal death. 13
Narcolepsy. 13
Chapter 15 Pickwickian Problems. 13
Chapter 16: And so to bed. 14
Chapter 17 An Excellent thing. 14


Introduction

What follows are my scant notes on what is an awesome and inspiring book, my advice is read it!!

Chapter 1: A Third of Life

There is a current prejudice, if you are asleep you are doing nothing. If you are doing nothing then you are not producing value. If you are not producing value in a consumerist society then you are worthless.
Our bodies are designed to have sleep according to circadian rhythms that hooks into the light of the day. Our sleep lives are regulated however by work schedules, electric light, alarms and caffeine.
Whilst attention to the body, to extend biological life, to enhance of desirability and esteem is something that is socially of concern to us, even if we don’t heed the advice. Sleep however is not, it doesn’t fit with our currents societies’ zeitgeist.
We can last longer without food that we can sleep, if we do not sleep are some time, not very long, our body forces us to go to sleep.
All species of animals sleep, and in terms of who sleeps the most and the least, we are on the low to middle ground at around 8 hours, 20 being the highest from the sloth.
Biological necessary behaviours can provide pleasure, e.g. sex, eating and drinking which help them be done, but sleeping is seemingly a source of neglected pleasure.
Sleep currently has the joyless status of 1950s canteen cooking, it is something done for refuelling, and the more quickly and more cheaply, the better.

Chapter 2: Sleepy People

The effects of sleep deprivation are daytime sleepiness, tiredness, loss of motivation, impaired cognitive faculty, decreases mood, decrease performance, loss of concentration, irritation, decrease of range of tasks people want to get involved in.
There is no right amount of sleep for people but 8 hours a night for an adult seems to suit most.  People sleep less than they used to and this seems related to a move to a long day, with work which now can extend around 24 hours as can entertainment plus caffeine in everything.  The work and success ethic keeps us from our bed, we use the work ethic to work harder being successful at work, and in social life, and sleep takes us away from that.
People used to sleep when it was dark, and work when it was light, the industrial revolution changed that with the electric light bulb which enabled us to work or socialise or to perform leisure activities through all house.  Where we used to sleep when we were tired, now we sleep according to clock time, we go to bed when it is time to go to bed, not when we are tired.
Through giving people long periods of dark, as would have been the experience in winter in pre-industrial northern Europe, then people slept in two 4 hour blocks punctuated by 2 quiet hours, during the night. So two quiet hours, then sleep, then wake then 2 quiet hours then sleep for four hours. Sleep length then used to vary with the seasons. Our current sleep pattern is one of permanent mid-summer.
Sleep deprivation causes car accidents, plane accidents, poor decisions and accidents in hospital. Sleep deprivation not only detracts from quality of life, it is also dangerous.

Chapter 3 Dead Tired

Whilst a poor night’s sleep can affect you strongly the next day a good night’s sleep can cure it. However chronic sleep deprivation can have a more insidious effect on you, your mood and your performance. Chronic sleep deprivation affects our creative problem solving, our judgement, mood physical health and social skills.
If you have not slept for 2 or three days you would need stimulation to keep you awake.  To tell how tired someone is you can measure it with sleep latency, the time it takes someone to get to sleep. The standard sleep day time latency is 15-25 minutes. Under 10 minutes would indicate a problem under 5 minutes would show excessive tiredness that was a cause for concern.  However some people can fall asleep very quickly and are not sleep deprived, so there are exceptions to this rule.
Sleepiness is affected by the last time you slept plus the time of the day. Stimulation can mask tiredness, busy people just don’t realise how tired they are.
Lack of sleep affects us emotionally, cognitively and behaviourally.  Emotionally we are less resilient and become more angry and irritable or sad. We have less energy and therefore less motivation. Our social skills are weakened, our brains don’t work as well, we have reduced focus, creativity and staying power.   Tiredness affects reaction times, and ability to put in sustained concentration or effort in something. Tired people are grumpy and reckless. Tired people become more inflexible and stick with standard responses, as they require less energy. They also take bigger risks, I guess as they might find the solution with one easy stroke, so need less effort to achieve their goals.
Growth hormones are produced during sleep, therefore the less sleep you get the less replenishment of your body you get and you see in middle age men the results of a loss of growth hormone with their double chins and pot bellies.
Sleep experiments, where deprivation of sleep happens for 90 hours results in hallucination, slurred speech, you basically feel like you are losing your mind after 2 or 3 days without sleep, indeed it is used as a torture by the military

Chapter 4 The Golden Chain

14:58 start
There is a link between sleep deprivation and poor physical health.  They have done experiments on dogs where they have forcibly kept them awake and they died within 20 days.  Sleep diminishes your perception, so vision is blurred but it has no effect on your physical strength.
Sleep deprivation can impair the efficiency of the immune system. It is argued that this is why sleep deprivation has proved fatal as the immune system stops working.  During infection the immune system issues chemicals that promote sleep\drowsiness\weariness and deep sleep within the sleep cycle.
One night without sleep can reverse the effect of immunisation, one night without sleep can increase cortisol levels by 45% which in turn reduces the immune systems efficiency.
Tired people are also more sensitive to pain, pain disrupts sleep, so you have a vicious cycle.

Chapter 5 The Shape of sleep

Human life has three states:
1.       Waking state
2.       Nrem Sleep
3.       Rem Sleep
Sleep is measured via an EEG machine, which measures electrical impulses from the brain.
A PSG machine measures brain activity, muscle tone and eye movement.
Falling asleep is not an abrupt process, rather it a continuous process moving from drowsiness to the first or second stage of sleep.  The movement between consciousness and sleep can be accompanied by hypnagogic dreams, which are generally less bizarre than standard dreams in sleep, in NRem and REM sleep. Indeed these sleep onset dreams can be seen as a watered down version from ordinary sleep.
Sleep latency=the length of time it takes you from wanting to fall asleep when you are laying down to when you actually do.
People with really long sleep latencies are generally either bored or ill. People with really short ones are generally sleep deprived.
The body’s core temperature drops an hour before the onset of sleep.  If you take a bath 2 hours before bed time this will have the same effect.  As the core temperature drops so the temperature in the feet and hand rises.

The sleep cycle

There are two section REM and Non Rem (NREM)
There are 4 parts of NREM, which relate to brain wave patterns.
Stage 1 NREM= muscles relax, brain wave patterns slow, lasts a couple of minutes, you can be easily awoken from this stage.
Stage 2 Brain waves patterns of K complexes and sleep spindles. K complexes are a brief burst of sleep wave that lasts under a second. Sleep spindles look on an EEG like a spindle moving across a loom. After 2 minutes you see delta brain waves, low frequency high amplitude, large waves slowly rolling across the screen.  Delta waves are the heralds of Stage 3 or deep sleep
Stage 3: Deep sleep, your eyes and muscles are still and relaxed
Stage 4: The deepest of deep sleep. Here you have slow rolling delta waves about 4 cycles a second. This is accompanied by profound muscle relaxation. This is the hardest state to be woken from and the one that you are most impervious to any sleep interruptions.  The first episode of stage 4 sleep lasts about 30 to 40 minutes
Stages 3 & 4 occupy 25% of our sleep time and are characterised by delta wave brain activity.
In Nrem sleep then the areas of brain where activity is most reduced is within the emotional and social behaviour areas, which is no surprise given that sleep deprivation affects these areas most.

After about an hour you have gone through Stages 1-4 of Nrem sleep, then you go into REM sleep

REM sleep

Has the same brain activity pattern as when awake, however the brain issues signals to prevent and signals being able to be sent to move the muscles, in effect the brain turns us into quadriplegics.  Rem sleep is also known as paradoxical sleep as it looks like from a brain scan you are awake.  Your brain is bombarding itself with stimuli but you are paralysed with the exception of your eyeballs.  Brain activity is intense in areas that process memories with an emotional content.
Your body is REM sleep is erratic, with breathing irregular, erogenous zones engorged and you have fluctuations in heart rate and temperature.  If you are awoken when you are in REM sleep there is an 80-90% chance you will be dreaming.
The body is paralysed as the brain sends out signals that block sensory inputs or muscular action. In NRem there is no paralysis and therefore this is the place where you get sleep walking, talking, teeth grinding etc.

The Sleep cycle continued

Each night’s sleep has 4-5 sleep cycles.  Each cycle starts with a descent into light slept NREM Stages 1 and 2 then slow wave sleep Stages 3 & 4, then a brief semi awaking then into REM sleep. One complete cycle lasts 90 mins in adults.  During progressive cycles the REM section becomes longer the short wave cycle, i.e. light sleep becomes shorter.  The final sleep episode before waking is an REM episode.  In a healthy adult they have 25% deep sleep, 25% REM sleep, and 50% light sleep. 
Periodically through the night you will awake briefly, i.e. be at very shallow sleep or on the edge of waking, but generally too quickly for you to be aware or for you to remember.  These are the body’s way of rising to the surface, seeing if there is anything dangerous around and if there’s not then sinking back down to sleep. During these partial awakenings you change your body posture. You change your body posture 30-40 times during the night.
All your sensory systems vision, sound, taste etc. have remained active, however the way that you process the input differs overnight. Sensory input influences your sleep although the full extent of this is not known. If you hear your own name or one that is significant to you then it will change your EEG pattern, again you are more likely to be woken by a noise that you would find irritating during the day rather than the level of noise.

Waking up

The body prepares you before you wake up. Your temperature rises and your hormone levels will change to help you get in gear. There is a hormone called ACTH that is produced about an hour before waking.
The grogginess we can experience in the morning is known as sleep inertia. Sleep deprivation increases the length of sleep inertia. Sleep inertia can last up to 3 hours, and is unaffected by morning routine!

Quality of sleep

You can measure the quality of sleep by Sleep efficiency:
Healthy sleeper has an efficiency of 90-95%
Insomniac 70-80%
Above 95% might indicate sleep deprivation.
Subjective reports of quality of sleep correlated with sleep efficiency. Another factor is amount of time in deep sleep, i.e. NREM stage3 or 4.Other facts are length of sleep and levels of immobility. So to summarise
Quality of sleep factors
1.       Sleep efficiently
2.       Amount of deep sleep
3.       Levels of immobility
4.       Length of sleep

Chapter 6: Morpheus Undressed

Sleep is an actively induced state. In REM sleep it is as active as when you are awake.
Rhythms of life
Virtually all bodily functions from cell biochemistry to social function exhibit a 24 hour cycle governed by an internal clock.  This clock is known as the circadian rhythm.  If you have sleep deprivation then it blunts this rhythm.  Circadian rhythms are universal characteristics of the living world. Circadian rhythms in humans apply to temperature, height, hormone production, digestion, urine production.
Some say the circadian rhythm evolved as the world revolves, it keeps us in sync and prepared for the changes in the day. Our circadian rhythm alters to external cues.
The electric light from a single lightbulb can reset the circadian clock. Light can be shone onto the knees to achieve the same effect.  The pineal gland produces melatonin when it is dark that affects how sleepy we feel.  Whilst the circadian clock does get reset, it has limits, so for instance submariners on an 18 hour day still exhibited the melatonin levels of a 24 hour day.
Growth hormones are secreted during sleep, in the first few episode of deep sleep. Between 30 and 40s the amount of growth hormone and the amount of deep sleep decreases. Testosterone levels reach their peak during the night and are depleted during the day.
The biological clock and circadian rhythm decreases as people age. So the daily differences in temperature and function are not as defined in older people.

Larks and Owls

Larks sleep pre 11pm and rise pre 8am. Most people are neither extreme larks nor owls, but 5-10% are markedly one or the other to a significant degree.
Larks have a circadian rhythm that is close to 24 hours, whereas owls have one that is over 24 hours and therefore they need to use environmental clues to manage their circadian rhythms, in fact you could argue their circadian rhythms don’t work.  Larks have consistently more cortisol in their systems.

Chapter 7 Strange tales of Erections and yawning

During REM sleep, which is standardly 4 half hourly sessions a night your genitals are engorged. Irrespective or age or sobriety this is the case. REM sleep does decline with age however, so there is less time spent engorged for the older person however.
Yawning is understood as a prompt to a change of behaviour, which is generally collective. The yawning when tired theory is challenged as yawning doesn’t change physiology not is always seen as a precursor to sleep, indeed soldiers yawn before battle
There is a connection between yawning and erections, the more someone yawns the more erections they have. This is because both behaviours are controlled by the same part of the brain. Dopamine is the main chemical transmitter for both yawns and hard-ons.

Chapter 8 Friends and enemies of sleep

Things that affect sleep

Caffeine:

This has a 7 hour half-life and is a stimulant that will keep you awake, it’s contained in coffee, tea, cocoa.  Caffeine works by inhibiting drowsiness, in large quantities it can produce adrenaline. People vary in their receptivity to caffeine

Alcohol

Alcohol helps us get to sleep, but reduces the amount of REM sleep in the second half of the night. Large doses do more harm than is good as far as sleep is concerned. Even middling amounts of alcohol drunk 6 hours before bedtime can affect sleep efficiency, REM sleep and total time asleep.
Insomnia is a notorious outcome of alcoholism.  There is  a vicious circle here where alcohol makes sleep easier, but disrupts sleep, produces insomnia with its adverse outcomes, which alcohol can be used to aid the low mood, or the insomnia, which in turn promotes it.

Tobacco

This is a central nervous stimulant and will increase the frequency of awakenings during the night.  Like caffeine nicotine provides a chemical boost when fatigue looms.

Food

Eating a large meal can make you feel sleepy, it could be this is because the body temperature drops when you are digesting, and a drop in body temperature is the herald to sleep. Spicy food can disrupt your sleep as it raises the body temperature, cheese can affect dreams as it takes longer to digest therefore can disrupt your sleep, which means you therefore can remember more of your dreams.

Exercise

Exercise does promote sleep although not directly, as fit people who take more exercise don’t sleep more. The probable relation is that it reduces anxiety which can affect sleep. It could be that if you have been very sedentary then you may find sleep difficult as your body is bored and exercise can help with that.

Noise

Repeated exposure to the same noise you habituate to it and it doesn’t wake you. Noise tends to act as a trigger to switch from deep sleep to shallow sleep.  40 Decibels affects sleep. 60 Decibels will wake people.  The quality of the noise and how it affects sleep matters, if the noise evokes an unpleasant emotion then it will be more evocative that if not.

Shift Work

Shift work is not good for you.  Shift work disrupts sleep and makes people tired.  There is a correlation between those who have worked shifts for over 10 years and heart disease.

Hypnotics

Drugs that induce drowsiness are called hypnotics. Natural hypnotics can be found in the amino acids of milky drinks. Melatonin can aid sleep as can certain smells: lavender oil.
Antihistamines can be hypnotics. The sleeping pills of the 70s have fallen out of favour as they created addictions and disrupted the quality of sleep. The modern drugs, e.g. zoplicone have little side effects and small chance of being addictive.

Chapter 9: Dreams

Dream themes:
Most dreams contain the dreamer and happen in the present.  Most characters in a dream are known to the dreamer. People with high verbal creativity have shorter dreams whilst those with high blood pressure have more dreams about hostility.  Dreams have a large emotional content.
During REM sleep the brain that processes rational content is less active and the area that processes emotional content more active.  Dreams are predominantly visual. Whilst dreams are wildly fantastical they are drawn out of elements of our lives.
We dream in NREM sleep but they are less vivid. If woken in NREM 6% of the time people say they are dreaming and 40% would say they are thinking.
Other animals dream and it seems the closer to humans in terms of consciousness the closer the likelihood that dreams are similar. 
It seems that recent\significant waking life provides most of the content for dreams and what happens in dreams influences how we lead our waking life.
The brain activity in a dream in similar to the content when someone is delirious.  There is an automatic amnesia for dreams that helps to keep a strong divide between dreaming and rationality.
People do standardly remember dream fragments and confuse them with a real memory.
Some psychiatric patients have difficulty in distinguishing their remembered dreams from a remembered reality.

Dreams could be understood as
1.       Wish fulfilment: Freud
a.       However how come we dream at regular intervals, and we dream as foetuses, and our levels of dreams decline as we grow old. If they are wish fulfilment\sexual why would any of this happen?
2.       Noise
a.       However we tend to dream about current concerns
3.       Consolidation of memory
4.       Working through conscious difficulties, so having the ability to work through all the various permutations of a current concern without committing yourself to any.



Chapter 10 A Second Life

Dreams seem to be play, a form of safe simulation. We disconnect our motoric capacity, mix up different ways of doing standard things, and then we can safely play. So we can try out different ways of behaving with no consequences.
Dreams can provide creative inspiration but it seems only if you have been working on that theme before you dream
Lucid dreams are dreams where you know you’re dreaming and can get certain things to happen.  They are relatively infrequent even for those who are well versed in them.

Chapter 11 from Egg to Grave

How the adult responds to the baby’s needs when they don’t sleep will affect how they sleep. How they sleep in turn affects how we respond to them.  A woman’s sleep alters according to their menstrual cycle.  There are generally sleep problems during pregnancy and a reduction of deep slow wave sleep.  REM sleep during pregnancy increases and the   amount of dreams does too. Babies have a circadian rhythm pre-birth, and can start sleeping 14-16 hours a day in blocks, which gradually reduces and turns into a single block. Children as adults can react to a lack of sleep and tiredness by being manic and keeping busy.
In teenage years our body clocks shift to a more owl like one.  We sleep less well in our old age and get less sleep, this doesn’t mean that we don’t need it.  AS we grow older we shift more to darkness.

Chapter 12 The Reason for sleep

Evolution of sleep
Primitive reptiles only have NREM Sleep. Primitive mammals do have REM sleep, therefore you can deduce that REM sleep evolved at a later stage than NREM sleep. Given that primitive as well as higher order animals have REM sleep, then it seems reasonable that REM sleep evolved to perform a basic function. Dreaming may well have been grafted onto REM sleep later in evolution, so there is the function REM sleep provides, that which NREM sleep provides, and then what the function of dreaming is.

What is sleep for

1.       Physical recuperation
2.       Saving energy
3.       Staying safe
There is some support, albeit limited, that sleep is for physical recuperation: the production of the building blocks of DNA increases during the night.  However some parts of the brain are more active than when awake, and sleep doesn’t vary according to physical exercise. So there is a part of sleep that is physically restorative but it is not the whole story.
Again there is some support for the saving energy argument as sleep varies when there is less food around, in humans and in animals. However we could get the same by just resting and purpose swim whilst sleeping.
The staying safe argument makes some sense in animals who can’t see at night, can’t get food, and will be hunted by those who can see at night, although this can’t account for baby humans who sleep most of the time. Still it’s more than possible that there are different purposes for sleep in different animals.
You may conclude that NREM has the purpose of giving the animal inactivity when it is the best strategy. Most large animals have NREM standing up, but need to lie down for REM sleep.

What is REM sleep for?

REM is a universal feature of large brained animals. Due to the specific brain activity that is REM sleep then it seems reasonable to assume that REM sleep is something to do with the brain. Young animals spend much more time in REM sleep that adults.
Dreams under represent and over represent, they in short distort through a number of ways but too much and too little are one aspect. I would note here that the author is conflating REM with dreams, but dreams happen within REM. REM has brain activity, paralysis and a certain muscle tone.

1.       Provide oxygen to the cornea (the aqueous fluid in the eye transports oxygen)
2.       Self-assembly of the brain: so the brain is cut off from sensory inputs so REM generates them. A cat deprived of one eye doesn’t grow as many visual processing brain cells
3.       Reverse learning: Watson and crick argue that information in the brain is stored over many synapses, and that too many things being remembered weakens the whole system, therefore the weaker memories get pruned and that is what happens in REM. They argue
that spurious memories are also pruned. However dreams are meaningful. Also we try to remember our dreams which would be the complete opposite of what their theory would argue but this is common in human culture and revered in many places
4.       Brain processes new information and consolidates memories:
a.       People have more REM sleep after doing a new task, if they don’t have REM sleep they forge the new task. Without REM sleep long term memory of what has been learnt is impaired.
b.      NREM sleep correlates with declarative sleep
c.       REM sleep correlates with procedural
5.       Resolving problems, emotional or otherwise

Chapter 13 Bad Sleepers

Insomnia is a symptom not a cause. Its homeland is USA, where one in three Americans have persistent sleep problems. Insomnia btw is persistent bad sleep. Insomnia increases in the over 60s.
The problems of sleep are:
1.       You are tired
a.       You can’t focus
b.      You can’t work on certain type of tasks
c.       Your social skills diminish
d.      You are more of a risk taker
e.      You lack motivation
2.       You don’t consolidate memories
3.       You don’t consolidate new skills
4.       The outcome of feeling tired is reduced activity which lowers mood

Why can’t you sleep

It is very hard to be objective about the quality of your sleep. No person has gone for sleep for more than a few days, you die if this is the case.
Reason for Insomnia
1.       Night shifts
2.       Respiratory problems
3.       Anxiety\depression\stress
4.       Caffeine
5.       Alcohol
6.       Migraines
7.       Pain

What to do to help sleep

1.       Only use bed for sex or sleep
2.       Go to bed at regular time and get up at one
3.       Have no disturbances in bedroom
4.       Avoid caffeine
5.       Pre bed relaxation routine

Treatment

1.       Zoplicone can be effective when taken once or twice a week
2.       CBT effective in achieving a 29% increase of the total sleep time

What to do to stay awake

1.       Caffeine works in the short term
2.       Sleep well the night before
3.       Napping
4.       Modafinil
5.       Physical exercise

Chapter 14 Dark Night

Some of the distress of sleep:
1.       Bed wetting
2.       Sudden death
3.       Sleep walking
4.       Night terrors
5.       Sleep paralysis
6.       Grinding teeth
7.       Nightmares
Sleep walking and talking at the product of NREM sleep. Benign in children but can be a sign of psychological difficulty if it persists into adult hood.
Night terrors: People awake with a sense of dread that there is an alien presence in the room
Sleep paralysis, you want to move but cant.
Night terrors and sleep paralysis are from waking from slow wave sleep. Like sleep walking and talking they arise in the first period of the night.
Nightmares happen during REM sleep. People who have regular nightmares are more likely to require hospital treatment for mental health difficulties during their lives.  People who have nightmares are easier to hypnotise.
To get rid of nightmares, tell yourself whilst awake you won’t have one and then do some CBT image work

Moving Sleep

You move in your sleep every 15-20 minutes, usually at the end of REM or slow wave sleep. This is necessary as you can get nerve damage if you lie on the same part too long. Your limbs may jerk during NREM sleep. We tend to notice these as we are dropping off to sleep as they can wake us up again. There is no correlation between limb movement and reported quality of sleep. If you really thrash about you might be suffering from REM sleep disorder where the signals to prevent muscle movement aren’t working correctly.
Occasional bedwetting can continue into adult hood in 1:200, more common in males than females
Teeth grinding: 8% do this once a week: causes of this heavy snoring, caffeine, alcohol, stress, anxiety and smoking.

Sleep and guts

There’s a subtle relationship reciprocal between sleep and guts. If you have a bad night’s sleep your digestive system may be upset. This can be because there is a gut rebuilding enzyme that is released at night.  IBS symptoms correlate with a good night’s sleep.

Troubled minds

Again there is a reciprocal relationship between psychological states and sleep.  Chronic insomnia, produces chronic fatigue that can leave you with depressive symptoms.  Sleep problems precede depression. SSRIS can cause detrimental problems on sleep, which can cause a vicious cycle.  One study showed that the best predictor of depression in old people was insomnia.
Depression affects REM sleep, it increases its amount and decreases the time it takes to get into it and a higher frequency of REM. The higher frequency of eye movements predicts suicide in schizophrenics and relapse in alcoholics.
Depriving depressed people of sleep can alleviate their depression, but it returns the next time they have sleep. This happens in 50% of the cases, and the other half nothing happens. Why this works is it correct an unusual pattern of brain activity. This could be rumination, self-criticism etc.

Sudden nocturnal death

Most likely explanation is cardiac arrest. Mostly happens to young Asian men, possibly as a result of nightmares. This would mean the increase of emotion causes a heart attack in someone with a pre-existing condition.

Narcolepsy

Can be triggered by emotional arousal. A Narcoleptic sleep has a very rapid onset on REM

Chapter 15 Pickwickian Problems

Snoring can have a decibel range of 70-90. When in REM sleep, our muscles relax, our upper airways become more constricted and greater effort is required to pull air through. Pulling air through quickly causes the elastic walls to vibrate as does any other loose tissue, back of tongues etc. The tongue and the fatty tissue of the soft palette are prime areas that cause the sound of snoring.
What causes snoring?
1.       Obesity
2.       Alcohol
3.       Nasal congestion
4.       A receding chin
5.       Gravity, allowing the tongue and other tissue to fall back into the air ways.
6.       Tiredness: the more deep sleep you have the more relaxed the more snoring is likely
Snoring sounds much worse than it is, people’s subjective rating to the noise of it bears little relation to the actual sound, it seems the irritation factor, through the type of sound and its intermittency is a major factor
1 in 3 men snore regularly. Habitual heavy snoring can dent your mental performance.

Chapter 16: And so to bed

Beds used to be a status symbol until two hundred years ago when the industrial revolution and light bulbs happened. There were day beds and night beds.
Two thirds of people sleep with a partner. Sleep deprivation can affect your partner. Until the eighteenth century many people shared a bed.
Couples movement is often synchronised and men move more than women. There is nothing to show that a baby that sleep with his parents, becomes less independent.
Sudden infant death syndrome is only a problem if you smoke or drink heavily and share a bed with your baby,

Chapter 17 An Excellent thing

The sense that sleep is a passive, purposeless waste of time is founded on fallacy.
Napping:
This works, indeed many people who were hailed as people who could work all the time and didn’t need sleep, Napoleon, Churchill were great nappers. A nap is intentional day time sleep between a few minutes and a few hours. Do not however use them if you are insomniac.
3 Types of Nap
1.       Prophylactic Nap
2.       Relief Nap
3.       Pleasure nap