CONSCIOUSNESS AND IT ALTERED STAGES. Muhammad Rehan BSN,RN Lecturer

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1 CONSCIOUSNESS AND IT ALTERED STAGES Muhammad Rehan BSN,RN Lecturer

2 What is CONSCIOUSNESS! Include all memories that remain within an individual s awarness. Event and experiences that are easily remembered. Example: telephone#, birthdays, and special holyday.

3 ALTERED STAGES OF CONSCIOUSNESS It exists whenever there is a change from an ordinary pattern of mental process functioning to a state that seem different to the person experiencing the change. Example drug like sedations or cocaine, heroine, sleep any pathological conditions, hypnosis.

4 REST- a state of calmness, relaxation without emotional stress, and freedom from anxiety SLEEP- an altered state of consciousness in which the individual s perception of and reaction to the environment are decreased.

5 Sleep This can be discussed simply by considering the three basic research approaches ELECTROPHYSIOLOGIC, HORMONAL and : NEURAL

6 Sleep Physiology ELECTROPHYSIOLOGIC Electrophysiological approach centers on the polygraph recordings of electrical changes in the brain waves (EEG), eye movements (EOG) and muscle activity (EMG). This approach characterizes sleep as Non- Rapid Eye Movement sleep (NREM) and the Rapid-Eye movement sleep (REM)

7 Sleep Physiology Neural The Neural approach views sleep as an active process involving the RETICULAR activating system (RAS) and the interaction of Neurotransmitters. The RAS is a network of neurons in the medulla, pons and midbrain with projections to the spinal cord, hypothalamus, cerebellum and cerebrum.

8 Sleep Physiology Neural SEROTONIN is said to be MAJOR neurotransmitter associated with sleep, produced in the median raphe nuclei of the brainstem. Serotonin decreases the activity of the RAS inducing sleep. REM sleep appears to be due to the influence of nor epinephrine.

9 Sleep Physiology Hormonal The Hormonal approach views sleep as a pattern affected by hormones. MELATONIN from the pineal gland in the brain is secreted in enormous quantities during sleep. Its activity is relationship of darkness and light.

10 Sleep Physiology Hormonal ACTH is also high during the early period of sleep and CORTISOL rises toward the end of the nighttime sleep period. GROWTH HORMONE and PROLACTIN also increase during deep sleep.

11 FUNCTIONS OF SLEEP 1. Restores normal levels of activity and normal balance among parts of the nervous system 2. Necessary for protein synthesis

12 TYPES OF SLEEP There are two types of sleep identified: The NREM sleep (or the non-rem sleep) The REM sleep( rapid eye movement sleep)

13 THE NREM SLEEP Also referred to as the SLOW wave sleep, because the brain waves of the client are slower than the alpha and beta waves of an awake or alert person. It is a deep, restful sleep There is a decreased physiologic functions All metabolic processes are reduced It is divided into FOUR stages:1-4

14 NREM Sleep STAGE 1- the stage of very light sleep, sleeper can readily be awakened, lasts for a few minutes. The eyes tend to roll slowly from side to side, and muscle tension remains absent. STAGE 2- the stage of light sleep, body processes continues to slow down, and lasts about minutes. Constitutes 40-45% of TOTAL sleep!

15 NREM Sleep STAGE 3- refers to a medium-depth sleep where vital signs and metabolic processes slow further because of the PARASYMPATHETIC nervous system influence. The sleeper is difficult to arouse.

16 NREM Sleep STAGE 4- this is the deepest sleep or delta sleep. It is the stage where the heart rate and respiratory rate drop 20-30% below those exhibited during waking hours. This stage is thought to restore the body physically. Some dreaming may occur here. This stage may be absent in the elderly.

17 THE REM SLEEP This sleep type usually recurs about every 90 min and lasts 5 to 30 minute Other name: PARADOXICAL Sleep The EEG pattern resembles that of the awake state This is not as restful as NREM sleep REM Sleep Most dreams take place during this period and the dreams are usually remembered or consolidated to memory s

18 REM Sleep The brain is highly active with metabolic rate increasing as much as 20% The sleeper may be very difficult to arouse There are rapid conjugate eye movements, muscle tone is depressed, but gastric secretions increase, HR and RR are increased and IRREGULAR This sleep period becomes longer as the night progresses.

19 NREM versus REM NREM REM Slow eye movement Restful sleep Decreased metabolism Vital signs LOW Muscle tone maintained NO vivid dreams Rapid Eye movement NOT restful Increased metabolism Vital signs Irregular Muscle tone depressed Dreams occur

20 Sleep Cycle All of us undergoes around 5 cycles of sleep of NREM to REM We begin with STAGE We begin with STAGE REM

21 Sleep cycle AWAKE Stage 1 Stage - 2 Stage - 3 Stage - 4 Stage - 3 Stage - 2 Stage REM Stage - 2 Stage - 3 Stage - 4

22 Sleep deprivation A prolonged disturbance in amount, quality and consistency of sleep Restlessness, irritability, withdrawal, speech deterioration

23 ALTERED SLEEP PATTERNS: COMMON SLEEP DISORDERS PARASOMNIAS Is a behavior that may interfere with Is a behavior that may interfere with sleep or a behavior that occurs normally during waking hours but abnormally during sleep.

24 CONTINUE.. PARASOMNIAS Bruxism- commonly called night teeth grinding occurring during stage 2 sleep. Nocturnal Enuresis- bedwetting occurring during sleep in children over 3 years old. It occurs in the following- 1-2 hours after falling asleep, and when rousing from NREM stages 3 to 4. dreams Nocturnal Erections/Emissions- wet dreams occurring during adolescence.

25 Continue.. Periodic Limb movements disordersthe legs jerk twice or three times per minute during sleep and is most common among elders. Sleep-talking- talking during sleep occurs during NREM sleep before the REM sleep. Somnambulism- sleepwalking occurs during stage 3 and 4 of NREM. It is episodic and occurs 1-2 hours after falling asleep.

26 PRIMARY SLEEP DISORDERS Defined as disorders in which the Defined as disorders in which the person s sleep problem is the main disorder.

27 Continue.. INSOMNIA MOST COMMON chronic sleep disorder, is the perceived difficulty or inability to obtain an adequate amount or quality of sleep; usually a result of physical discomfort, and often due to mental over- stimulation due to anxiety. Treatment includes developing new behavior pattern that induce sleep.

28 Continue INITIAL INSOMNIA- difficulty in falling asleep INTERMITTENT INSOMNIAdifficulty in staying asleep because of frequent or prolonged waking TERMINAL INSOMNIA- early morning or premature waking

29 Continue.. HYPERSOMNIA- excessive sleep, particularly in the daytime. Causes can be medical conditions like CNS damage, kidney, liver or metabolic disorders like diabetes and hypothyroidism NARCOLEPSY is a sudden wave of overwhelming or irresistible sleep attacks and sleepiness that occurs during the day. The person with narcolepsy literally fall asleep standing up, while driving a car, in the middle of conversation or even while swimming

30 Continue NARCOLEPSY The cause is UNKNOWN. Hypothesis includes the decreased HYPOCRETIN in the CNS that regulates sleep. The sleep starts directly with REM phase. The patient may have cataplexy (sudden loss of motor tone), hypnagogic hallucinations (nightmare or vivid dream) and sleep paralysis. Drug therapy includes MODAFINIL and Ritalin (stimulants) that may cause wakefulness

31 Continue SLEEP APNEA- is the periodic cessation of breathing during sleep. Usually, the period of apnea lasts from 10 seconds to 2 minutes occurring at least 5 times per hour. This usually gives rise to oxygen desaturation and carbon dioxide retention. POLYSOMNOGRAPHY is the only method that can confirm sleep apnea.

32 Continue Obstructive sleep apnea- occurs when the structures of the pharynx or oral cavity block the airflow. Central apnea- involves a defect in the respiratory center in the brain with neurological failure to trigger respiratory effort. Mixed apnea- a combination central and obstructive apnea.

33 What is Dreams Are sequence images, sounds and feelings experienced while sleeping, particularly strongly associated with rapid eye movement sleep.

34 Dream content From the 1940s to 1985, Calvin S. Hall collected more than 50,000 dream reports at Western Reserve University. In 1966 Hall and Van De Castle published The Content Analysis of Dreams in which they outlined a coding system to study 1,000 dream reports from college students. It was found that people all over the world dream of mostly the same things. Hall's complete dream reports became publicly available in the mid-1990s by Hall's protégé William Domhoff, allowing further different analysis.

35 Emotions The most common emotion experienced in dreams is anxiety. Negative emotions are more common than positive ones.the U.S. ranks the highest amongst industrialized nations for aggression in dreams with 50 percent of U.S. males reporting aggression in dreams, compared to 32 percent for Dutch men.

36 Sexual content The Hall data analysis shows that sexual dreams occur no more than 10 percent of the time and are more prevalent in young to mid teens. Another study showed that 8% of men's and women's dreams have sexual content. In some cases, sexual dreams may result in orgasm or nocturnal emission. These are commonly known as wet dreams.

37 Recurring dreams While the content of most dreams is dreamt only once, many people experience recurring dreams that is, the same dream narrative is experienced over different occasions of sleep. Up to 70% of females and 65% of males report recurrent dreams.

38 Common themes Content-analysis studies have identified common reported themes in dreams. These include: situations relating to school, being chased, running slowly in place, experiences, falling, arriving too late, a person now alive being dead, teeth falling out, flying, future events such as birthdays, anniversaries, etc. (with different scenarios), embarrassing moments, falling in love with random people, failing an examination, not being able to move, not being able to focus vision and car accidents.

39 Color vs. Black and White Twelve percent of people dream only in black and white.studies from 1915 through to the 1950s maintained that the majority of dreams were in black and white, but these results began to change in the 1960s. Today, only 4.4 % of the dreams of under-25 year-olds are in black and white. Recent research has suggested that those changing results may be linked to the switch from black-and-white film and TV to color media.

40 Relationship with mental conditions There is evidence that certain medical conditions (normally only neurological conditions) can impact dreams. For instance, people with synesthesia have never reported black-andwhite dreaming, and often have a difficult time imagining the idea of dreaming in only black and white. Therapy for recurring nightmares (often associated with posttraumatic stress disorder) can include imagining alternative scenarios that could begin at each step of the dream.

41 Hypnosis is a distinctive, often trance-like mental state that is induced by an organized pattern of suggestions, usually verbal in nature, beginning with the suggestion of relaxation. The suggestions may be directly induced by a hypnotist in the presence of the subject, but may be also be self-induced (self-hypnosis or autohypnosis/auto-suggestion).

42 Continue According to the American Psychological Association's Division 30, hypnosis may bring about "...changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior.

43 Uses of hypnosis Hypnosis has been studied in many clinical situations with varying degrees of success.it has been used as a painkiller, an adjunct to weight loss, a treatment of skin disease, and a way to soothe anxious surgical patients. It has also been used as part of psychological therapy, a method of habit control, a way to relax, and a tool to enhance sports performance.

44 Physical applications "Hypnobirthing" is one popular application of hypnosis. A large number of clinical studies show that hypnosis can reduce the pain experienced by people undergoing burn-wound debridement, bone marrow aspirations, and childbirth. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.

45 Psychotherapeutic applications Self-hypnosis (sometimes called autosuggestion) happens when a person hypnotizes himself or herself. The technique is often used to increase motivation for a diet, quit smoking, or reduce stress. People who practice self-hypnosis sometimes require assistance to enter trance; some people use devices known as mind machines to assist in the process, while others use hypnotic recordings. Self-hypnosis is said to be a skill one can improve as time goes by, and can help reduce stage fright, promote relaxation, and enhance physical well-being.

46 Other uses Stage hypnotism is a form of entertainment for crowds. Due to stage hypnotists' showmanship, many people believe hypnosis is a sort of mind control. However, the real power of stage hypnosis comes from people granting hypnotists the ability to take over their critical thinking. The desire to be the center of attention, having an excuse to violate their own inner fear suppressors and the pressure to please are thought to convince subjects to 'play along'.

States of Consciousness

States of Consciousness Sleep, Dreams, and Body Rhythms Introduction Consciousness Awareness of oneself and one s environment Body Rhythms Biological Rhythms Periodic physiological fluctuations Can affect