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Clinical Psychology > Week 3 Lecture - Insomnia and mental health > Flashcards

Week 3 Lecture - Insomnia and mental health Flashcards

1
Q

features of actigraph - what are they and what do they measure?

A
  • Gives sleep outcomes
  • Wearable device
  • Measures things like duration of sleep, sleep onset latency etc
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2
Q

optimal sleep duration

A

7-9hours

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3
Q

normal sleep onset latency

A

15mins

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4
Q

features of the attogram/photometry - what do the different colours mean

A
  • Black lines are movement (proprietary algorithm)
  • Blue is sleep period
  • Yellow is Light sensory so light intensity (essential in sleep regulation - can assist us in sleeping or inhibit sleeping, indicates whether we are asleep during a certain period)
  • Green is the period of uncertainty (trying to measure sleep onset latency)
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5
Q

what is polysomnography (PSG) and what does it record?

A
  • Electrodes on head/face (usually)
  • Records electrical activity of brain
    o Converted and interpreted
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6
Q

features of polyomnograph

A

amplitude and frequency to stage sleep

  • The more asleep you are, the higher the amplitude and lower frequency
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7
Q

stages of sleep

A

N1 = drowsy
N2 = light sleep
N3 = deep sleep
R = REM sleep

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8
Q

how many sleep cycles per night

A

4-5

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9
Q

what is light sleep good for?

A

memory consolidation

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10
Q

what is deep sleep good for?

A

deep repair mode, growth hormone released in this period

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11
Q

what is REM sleep?

A

dream stage, closest to being awake, lots of brain areas active

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12
Q

when does most deep sleep occur?

A

during first part of night (before 2am)

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13
Q

when does most REM sleep occur?

A

towards end of sleep

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14
Q

how does the polysomnogram score sleep?

A

in 30s blocks

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15
Q

what happens to eyes during REM sleep

A

eyes move and roll during sleep

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16
Q

process behind REM sleep

A

Physiological process that paralyzes the body from neck down to stop us re-enacting dreams (EMG electrodes on body therefore have no activity)

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17
Q

how do we measure depth of sleep

A

auditory arousal threshold

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18
Q

auditory arousal threshold

A

the minimum amount of noise required to arouse someone from a given stage of sleep

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19
Q

stages of sleep and noise

A
  • Deeper stages require more noise (and more energy)
    o Important for fire alarms etc
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20
Q

what does a hypnogram show?

A

sleep cycles

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21
Q

what can anxiety do to sleep onset latency

A

may cause it to be longer

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22
Q

what can depression do to sleep cycle?

A

may cause people to wake up in middle of night and not go back to sleep

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23
Q

how many processes control sleep?

A

3

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24
Q

3 processes controlling sleep

A
  • Homeostatic processes (physiological balance)
  • Circadian processes (biological clock)
  • Psychological processes (learning, cognitive arousal, automaticity)
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25
Q

what homeostatic process controls sleep?

A

sleep homeostasis: sleep pressure

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26
Q

sleep pressure

A

accumulation of hormone in brain called adenosine which starts building up as soon as you wake up. Builds up over day and highest in evening.

27
Q

ways to combat adenosine

A

coffee which binds with adenosine and stops its action in brain

28
Q

sleep homeostasis

A

sleep pressure

Builds up until critical level until wakefulness can no longer be maintained

Levels dissipate during sleep

Gone by morning and then process starts again upon waking

Accumulation of sleep pressure over the days of late nights where there is sleep deprivation (by the 3rd of 4th day you will need to catch up)

Napping can be used to dissipate adenosine

29
Q

how long is the circadian process?

A

24h

30
Q

how are circadian rhythms entrained?

A

mediated by non-image forming retinal cells (intrinsically photosensitive retinal ganglion cells or ipRGCs) (entrained to environment)

ipRGCs link directly to the suprachiasmatic nucleus in pineal gland

Light suppresses melatonin secretion, which rises in darkness and signals body to rest

31
Q

interaction of homeostatic and circadian processes

A
  • Adenosine accumulates in brain but circadian rhythm counteracts physiological process and stimulates other physiological to allow us to be alert and stay awake for at least 14-16 hours
32
Q

optimal time for napping

A
  • Between 2 and 4pm optimal time for nap as adenosine is high
    o Keep less than 30mins so you don’t go into deep sleep
33
Q

sleep onset is most probable when…

A

o We are appropriately sleepy (enough sleep pressure)
o We go to bed at the appropriate time
o We are appropriately calm (state of mind)
o The sleep environment is familiar and associated with restfulness

34
Q

how common are sleep problems

A

Top psychological symptoms among UK adults

most mental health issues have sleep problems as one of their symptoms

35
Q

use of hypnotic drugs

A

widely prescribed for insomnia as a first line of treatment

36
Q

prevalence of sleep problems across the world

A

o Same story across the world, more in females and age.
o Gets more common with increasing age as sleep cycles change, less deep sleep, more lighter sleep, making opportunity to be woken in night more likely as sleep is lighter

37
Q

insomnia and common mental health problems interactions

A
  • Accompanies and is in diagnosis for lots of common mental health disorders like MDD and anxiety
38
Q

insomnia before 2005

A

primary and secondary insomnia

39
Q

primary insomnia

A

insomnia with no comorbidity

40
Q

secondary insomnia

A

insomnia resulting from comorbid conditions (e.g. depression)

41
Q

outcome evidence about primary and secondary insomnia (2006)

A
  • 2 strong arguments against secondary insomnia
  • [CBT-I] “…has been shown to be effective in treating patients with insomnia assumed to be secondary”
  • “…insomnia often continues after the presumed primary disorder has remitted”.
42
Q

Insomnia disorder DSM5 2013

A
  • Persistent complaint (at least 3 times a week for at least the previous 3 months) of:
    o Difficulty initiating or maintaining sleep despite opportunity to sleep which causes significant distress and is associated with impaired social or occupational functioning.
43
Q

consequences of insomnia

A
  • Chronic fatigue
  • Emotional dysregulation
  • Cog and psychomotor impairment
  • Increased accident risk
  • Delayed recovery from acute illness episode
  • Increase healthcare utilisation
  • Independent risk factor for other mental health conditions (below)
    o Depression
    o Anxiety
    o Alcohol abuse
    o Possible psychotic symptoms
44
Q

insomnia effects what % of population?

A

approx 10%

45
Q

what model do we use for insomnia

A

The Spielman 3P model

46
Q

The Spielman 3P model

A

o Predisposing factors
* People with insomnia can be characterised by a behavioural phenotype showing: attentional bias, higher trait anxiety, a propensity to ruminate/catastrophise

o Precipitating factors

o Perpetuating factors

47
Q

3 key psychological factors influential in regulation of sleep

A
  • Cognitive arousal (being appropriately calm, controlling arousal)
  • Learning
  • Automaticity (sleep is an automatic process, don’t think about it, habit)
48
Q

2 psychological theories of cognitive arousal

A
  • Harvey (2002): selective attention –> monitoring
  • Espie et al (2006): selective attention –> the A-I-E pathway
49
Q

Espies model of insomnia and arousal

A
  • Arousal –>
  • Selective attention to delayed sleep onset
  • Compensatory intention to fall asleep
  • Counterproductive deployment of sleep effort
  • –> arousal
  • Everything starts with a problem inhibiting wakefulness , disfunction in selective attention
  • Realise you aren’t asleep (selective attention), then tell yourself you are going to sleep (intention) and therefore there is sleep effort as you try to shut down your mind but it does the opposite
  • Intention makes sleep no longer automatic
50
Q

the attention - intention - effort pathway automaticity

A
  • Sleep effort means loss of ‘automaticity’
  • Sleep effort generates performance anxiety and LONGER sleep latencies
    So
  • We fall asleep best when we don’t ‘try’ to sleep
    But
  • If chronic, arousal-delayed sleep onset can impact learning processes
51
Q

learning takes place through…

A

o Reward/reinforcement (operant conditioning) or
o Pairing (classical conditioning)

52
Q

stimulus control of sleep

A
  • Adopting the state which leads to sleep is rewarded (reinforced) by sleep onset
  • Through repeated episodes of reinforcement, the bedroom acquires discriminative stimulus properties for reinforcement
  • Discriminative stimuli make behaviour (previously reinforced in their presence) more likely
  • For people with chronic insomnia, bedroom environments stop promoting rest and sleep and they start promoting cognitive arousal
53
Q

what does chronic insomnia do to learned interactions?

A

extinguishes learned associations between the bedroom and sleep onset

  • As a result, the ability of the bedroom environment to signal sleep is diminished
  • Doing other things in bedroom apart from sleep may weaken connection between bedrroom and sleep signal
54
Q

conditioned emotional response and insomnia

A
  • Repeated associations between the frustration of delayed sleep onset and the sleep environment
  • Classical conditioning of negative emotions (conditioned arousal) on going to bed
55
Q

CBT-I for insomnia - treatment outcomes of CBT-I

A
  • Reviews/meta analyses of >40 studies
  • “5 hours psychological treatment… produces reliable and lasting improvements …among 70-80% of treated patients”
    Source: Morin et al (1999).
56
Q

NICE and hypnotic use

A

o Should only be prescribed for short period of time or during time of crisis, not for ongoing problem with sleep

57
Q

what is CBT-I?

A
  • An integrated package of cognitive and behavioural interventions designed to:
    o Reduce sleep latencies - main complaint of insomnia
    o Increase sleep efficiency - don’t do anything in bed apart from sleep
    o Re-establish stimulus control - relearn stimulus control and make discriminations of stimulus as bed is for sleep. What therapy is trying to do.
58
Q

steps to CBT-I

A

first = sleep education

sleep hygiene
sleep restriction
stimulus control
relaxation
cognitive therapy

59
Q

sleep hygiene

A

reducing dysfunctional beliefs/amplifying circadian control - expose yourself to light during day, engage in physical activity, regular meals etc

60
Q

sleep restriction

A

increase homeostatic sleep pressure at bedtime - one of the most powerful steps, period of a few weeks where sleep is restricted so sleep pressure is accumulated due to sleep deprivation

61
Q

stimulus control

A

managed wakefulness (and the 15 minute rule) - reassociating bed and sleep onset. If not asleep in 15 minutes, get up and do something and then try again

62
Q

relaxation

A

reduce cognitive arousal/PMR - can follow an online recording

63
Q

cognitive therapy stage

A

reduce cognitive arousal at night (restructuring - thought blocking)

Clinical Psychology (25 decks)

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