KKDP 1
Sleep as a psychological construct that is broadly categorised as a naturally occurring
altered state of consciousness and is further categorised into REM and NREM sleep, and
the measurement of physiological responses associated with sleep, through
electroencephalography (EEG), electromyography (EMG), electro-oculography (EOG),
sleep diaries and video monitoring
Consciousness
The awareness of your own internal mental processes, including your thoughts, feelings,
sensations, perceptions, and your awareness of the external world around you.
Consciousness is unique and subjective to the individual experiencing it and is constantly
changing. It is a psychological construct as it cannot be objectively observed or measured
through the collection of data, but is widely understood to exist. Our consciousness shifts
through different levels of awareness.
Consciousness can only indirectly be measured through qualities that are more easily
assessed, such as physiological changes or observable behaviours through self-reporting.
A consciousness stream is the flow of thoughts in the conscious mind.
Consciousness continuum
Our level of consciousness can be placed on a continuum ranging from being highly focused
and alert through having no thoughts, feelings or sensations at all.
Normal waking consciousness - NWC
A state associated with being aware of our internal and external environments.
Altered states of consciousness - ASC
Any state that differs in awareness from normal waking consciousness.
Sleep
A naturally occurring and reversible altered state of consciousness characterised by a
reduction in awareness and responsiveness to external surroundings. Characteristics:
•Involves unique brain wave patterns
•Two stages: REM and NREM
•5x 90 minute cycles per night (8 hours of sleep per night)
•Physiological changes.
NREM sleep (non-rapid eye movement sleep)
NREM sleep is characterised by a progressive decline in physiological activity. Consists of 3
stages and takes up 80% of sleep time, which decreases in amount as the night progresses.
Stage 1 Stage 2 Stage 3
‘Light sleep’ - transitional Still considered ‘light sleep’ ‘Deep sleep’
stage
Still able to be woken up, Physiological responses are
Physiological responses however, brain activity limits at their slowest.
slow down (brain activity, this more than Stage 1.
heart rate, breathing). ‘Slow wave’ sleep (brain
waves)
If there are no disturbances,
sleep quickly moves to Experienced more in the
NREM Stage 2. first half of the night.
REM sleep (rapid-eye movement sleep)
Brain activity resembles ‘wakefulness’ and breathing and heart rate increases. Your eyes
make quick darting movements behind closed eyelids and your physiological activity
increases. A period of REM sleep occurs at the end of each sleep cycle.
Hypnogram
A line graph that represents the stages of sleep.
The person goes into REM, then N1, N2, and N3 and cycles through. Betty wakes up in the
4th and 5th cycle. Betty had 8 hours of sleep. REM increases in duration as sleep
progresses. 1st, 2nd, 3rd cycle there is N3, which is not present in the 4th and 5th cycle.
REM sleep vs NREM sleep
NREM REM
Brain activity Brain activity decreases from Brain activity increases in motor
wakefulness. and sensory areas, while other
areas are similar to NREM.
Heart rate Heart rate slows from Heart rate increases and varies
wakefulness. from NREM.
Blood pressure Blood pressure decreases from Blood pressure increases and
wakefulness. varies from NREM.
Respiration Respiration decreases from Respiration increases and varies
wakefulness. from NREM.
Muscle tone Muscle tone is similar to Muscle tone is absent.
(muscle movement) wakefulness.
Body temperature Body temperature is regulated Body temperature changes to
at a lower set point than more of the local environment.
wakefulness.
Measuring sleep
Onset of sleep, sleep duration, sleep quality, awakenings during sleep, any body movements
and wake-up time are all things that can be measured.
Methods to measure sleep are important as they can diagnose sleep disorders where you
can’t just rely on self-reporting.
Electroencephalography (EEG)
A technique that detects, amplifies and records the electrical activity of the brain.
Electrodes are attached to a person’s scalp where they detect electrical impulses from the
neurons communicating, where the data is transmitted and amplifies the signals recorded as
brain wave patterns.
Brain waves
The frequency of brain waves indicates the speed of the brain waves or how much activity
is occurring every second (how often).
Slower-frequency brain waves are prevalent when we are tired, relaxed or asleep.
Faster-frequency brain waves are prevalent when we are awake and alert.
The amplitude of brain waves indicates the intensity or strength of the brain wave or how
many neurons are firing at the same time together.
A high amplitude indicates more synchronised brain activity from multiple neurons working
on a similar task (e.g. sleep).
A low amplitude indicates that groups of neurons are working on different tasks (e.g. driving
a car).
To remember brain wave hierarchy = BATD from high to low alertness (beta, alpha,
theta, delta)
Brain waves
😄
Mood Brain wave Frequency and State
Amplitude
Beta Frequency: highest •Normal waking consciousness
Amplitude: lowest •Awake, alert and focused
•High environmental stimulation
🙂
•Brain working on several things
at once
Alpha Frequency: high •Lower alertness
Amplitude: low •Awake but relaxed
•Quiet and calm
😑
•Drowsy, eyes closed
•Low environmental stimulation
Theta Frequency: low •Low alertness
Amplitude: high •Light sleep
•Senses withdrawn from external
😴
environment
•Deep meditation
Delta Frequency: lowest •Lowest alertness
Amplitude: highest •Deep N3 sleep
•Dreamless sleep
Electromyography (EMG) - m for skeletal muscles
A technique that detects, amplifies and records the electrical activity of the skeletal
muscles.
An EMG is used to measure sleep when you go through different stages of sleep where
muscle tension changes.
Electrooculography (EOG) - o for eye
A technique that detects, amplifies and records the electrical activity of the muscles
controlling the eyes.
Electrodes are placed where the eye muscles are located, and detect muscle movement
around the eyes.
Sleep diary
A subjective, self-report tool used by a person to track their own sleep-wake patterns. They
aim to identify any patterns or habits that may be leading to sleep trouble.
Video monitoring
Validates EOG, EEG and EMGs by showing exactly what activity is occurring whilst a person
is asleep, such as their sleeping positions, specific movements, laboured breathing, sleep
talking/walking and teeth grinding.
Remember sleep measuring techniques = DARE - detect, amplify, record the electrical
activity of the brain / skeletal muscles / muscles controlling the eyes.
KKDP 2
Regulation of sleep-wake patterns by internal biological mechanisms, with reference to
circadian rhythm, ultradian rhythms of REM and NREM Stages 1–3, the
suprachiasmatic nucleus and melatonin
Regulating sleep-wake patterns
Biological mechanisms are repeated biological processes that are regulated by internal
mechanisms.
Sleep is controlled by several biological mechanisms such as circadian rhythm, ultradian
rhythm, suprachiasmatic nucleus and melatonin.
Circadian rhythm
A physical, mental and behavioural process that coordinates the timing of activity of body
systems over a 24 hour period. A circadian rhythm allows for optimal functioning at a certain
time point over the course of 24 hours.
An example of a circadian rhythm is a sleep-wake cycle.
Ultradian rhythm
A physical, mental and behavioural process that are repeated within cycles that last less
than 24 hours.
An example of an ultradian rhythm is a sleep cycle (the 90 minute period during sleep).
Suprachiasmatic nucleus
At specific times in a 24 hour day, the suprachiasmatic nucleus sends signals to regulate
various activities in the body and keep it functioning to a daily schedule of sleep and
wakefulness. The suprachiasmatic nucleus is known as the ‘master body clock’ and is part of
the hypothalamus, which synchronises and controls the circadian rhythm. The
suprachiasmatic nucleus is sensitive to light.
A zeitgeber is an external cue that influences sleep, such as light.
Melatonin
A hormone that induces drowsiness and decreases cell activity. Light sensitive cells are
found in the retina of the eye.
The role of the pineal gland and suprachiasmatic nucleus in melatonin release:
At nighttime when the light sensitive cells in the retina detect no light, the suprachiasmatic
nucleus sends neural messages to the pineal gland to release melatonin into the
bloodstream, inducing drowsiness and decreasing cell activity.
During the daytime the light sensitive cells in the retina detect light and the suprachiasmatic
nucleus sends neural messages to the pineal gland to inhibit melatonin release, promoting
wakefulness.
KKDP 3
Differences in, and explanations for, the demands for sleep across the lifespan, with
reference to total amount of sleep and changes in a typical pattern of sleep (proportion
of REM and NREM)
Theories that describe why we need to sleep:
• Sleep is necessary for repair and restoration of the body
• Repairs tissues, replenishes neurotransmitters and removes waste products
• Allows us to conserve energy and remain safe during potential times of danger at night
time (evolutionary)
• Allows for information to be received during the day to be processed and consolidated,
helping with memory.
Examples where sleep varies between individuals:
● Biological examples: medications, caffeine
● Psychological examples: stress
● Social examples: access to housing and a bed, temperature of room.
Sleep across the lifespan
As we age our sleep patterns change, where the duration, amount of REM sleep and N3
sleep, sleep efficiency reduces as we age, and awakenings during the night increase.
Total Percentage of Explanation of sleep patterns
Age group recommended REM and
hours of sleep NREM sleep
Newborn 14 – 17 hours REM: 50% •Require the highest amount of total sleep for rapid
0-3 months NREM: 50% growth and development.
•Highest proportion of REM sleep to help
consolidate learning and memory.
•Muscle twitches in REM sleep help develop their
sensorimotor system, coordinating sensory
experiences and motor actions.
Infant 12 – 16 hours REM: 30-40% •Sleep for longer periods at a time as their
4-11 months NREM: 60-70% circadian rhythm develops a more regular sleep
pattern following day-night cycles.
Toddler 11 – 14 hours REM: 25-30% •Proportion of REM sleep has its greatest decline
1-2 years NREM: 70-75% and only decreases a small amount over the rest
of the lifespan.
Pre-schooler 10 – 13 hours REM: 25% •Timing of circadian rhythm advances and sleep
3-4 years NREM: 75% onset shifts to earlier in the evening as they begin
to drop their daytime naps.
Primary 9 – 11 hours REM: 20% •Timing of circadian rhythm gradually delays and
school age NREM: 80% sleep shifts to later in the evening.
6-13 years
Adolescent 8 – 10 hours REM: 20% •Delay in circadian rhythm because of hormone
14-17 years NREM: 80% determined shift in melatonin released 1-2 hours
later than other age groups.
•Increasing school-related requirements,
increasing independence, easy access to devices
for constant entertainment and social networks all
contribute to a delayed bedtime.
Young adult 7 – 9 hours REM: 20% •Sleep patterns can alter because of psychosocial
18-25 years NREM: 80% factors such as study, work requirements, social
schedules and increasing independence.
•Circadian rhythm advances, resulting in
preference for earlier sleep time.
•Melatonin concentrations begin to decline after
puberty.
Adult 7 – 9 hours REM: 20% •Sleep patterns can be altered as a result of
26-64 years NREM: 80% lifestyle changes (e.g. caring for children),
changing work, social requirements and health
problems.
•N3 sleep begins to decline and is replaced by N2
sleep.
•Melatonin concentration continues to decline.
Older adult 7 – 8 hours REM: 18-20% •Sleep patterns can be altered by lifestyle changes
65+ years NREM: 80-82% (e.g. retirement), increased health issues, sleep
disorders and decreased social interactions.
•Less sleep as circadian rhythm advances.
•N3 continues to decline and is replaced by N2
sleep.
•Increase in sleep latency and multiple awakenings
during sleep.
•Melatonin concentrations continue to decline.
•Impaired ability to obtain sleep.
KKDP 4
The effects of partial sleep deprivation (inadequate sleep either in quantity or quality) on
a person’s affective, behavioural and cognitive functioning, and the affective and
cognitive effects of one night of full sleep deprivation as a comparison to blood
alcohol concentration readings of 0.05 and 0.10
Sleep deprivation / partial sleep deprivation
The experience of achieving inadequate sleep in terms of quantity or quality. It reduces the
ability for us to restore the body and consolidate the mind.
Both quantity (number of hours slept) and quality (how well you slept) of sleep needs to be
considered because even if you thought you were getting enough hours of sleep for your
age, your sleep may be disrupted, resulting in poor quality sleep.
Factors that affect sleep deprivation
• Caffeine, alcohol, drugs
• Failing to wind down before bed
• Social influences
• Stress
• Food/diet
• Medical conditions
• Work or school requirements.
ABCs of sleep deprivation
Affective: emotions
Behavioural: observable actions
Cognitive: mental processing.
An example of their interaction; poor concentration (cognitive), may lead to increased
clumsiness (behavioural), which may lead to increased frustration (affective).
Affective functioning
An individual experiencing sleep deprivation may have trouble regulating or controlling their
emotions, experience mood swings, emotional outbursts, feel sad or depressed, are more
irritable, or cry for no apparent reason.
Behavioural functioning
An individual experiencing sleep deprivation may have trouble controlling their behaviour,
participate in more risky or impulsive behaviour, take longer finishing tasks, have reduced
productivity, and be more accident prone. Children show hyperactive behaviour and
increased misbehaviour.
Cognitive functioning
An individual experiencing sleep deprivation may have trouble with memory, decreased
alertness, lack of motivation, and poor concentration.
Blood Alcohol Concentration - BAC
Percentage of alcohol in the bloodstream. In grams per 100mL of blood, so a BAC of 0.08
means your blood is 0.08% alcohol by volume.
The effect of someone who has a BAC of 0.05% has a detrimental effect on a person’s
functioning, including their affective and cognitive functioning.
Sleep deprivation compared to Blood Alcohol Concentration
The effects of 17 hours of sustained wakefulness are equivalent to the effects of a blood
alcohol concentration of 0.05%.
The effects of 24 hours of sustained wakefulness are equivalent to the effects of a blood
alcohol concentration of 0.10%, which is above the legal BAC limit for driving in Australia.
Sleep deprivation compared with BAC: Affective functioning
The detrimental effects of sleep deprivation and an increased BAC on affective functioning is
that emotions are amplified, exaggerated or completely absent.
When driving, these affect the person to make safe decisions (e.g. encourage thrill-seeking
behaviour or recklessness).
Sleep deprivation compared with BAC: Cognitive functioning
The detrimental effects of sleep deprivation and an increased BAC on cognitive functioning
is that a person has poorer concentration and impaired logic, reasoning, attention,
decision-making and problem solving ability.
When driving, this can look like failing to give way, misjudging distances and forgetting road
rules.
KKDP 5
Changes to a person’s sleep-wake cycle that cause circadian rhythm sleep disorders
(Delayed Sleep Phase Syndrome [DSPS], Advanced Sleep Phase Disorder [ASPD] and
shift work) and the treatments of circadian rhythm sleep disorders through bright light
therapy
DSM-5
Diagnostic and Statistical Manual of Mental Disorders - 5th edition
Circadian rhythm sleep disorders
A category of sleep disorders characterised by a persistent pattern of sleep distribution due
to a misalignment between the circadian rhythm and the sleep-wake cycle required by a
person.
A misalignment of sleep causes excessive sleepiness, insomnia, distress, or impairment of a
person’s functioning. They may also be unable to sleep and wake at appropriate times.
Delayed Sleep Phase Syndrome (DSPS)
A circadian rhythm sleep syndrome characterised by a delay in the timing of sleep onset and
wakening.
A person more sensitive to light in the evening may have a delayed nighttime signal to
the suprachiasmatic nucleus, which delays melatonin release by the pineal gland, resulting
in fewer signals to the body that it is time to sleep.
A person less sensitive to morning light upon waking has a lack of light cues to the
suprachiasmatic nucleus to signal a reduction in melatonin release by the pineal gland.
DSPS is caused by lifestyle factors, poor sleep habits, shift work, jetlag, adolescence etc.
DSPS is common in adolescence as the release of melatonin is delayed for up to 2 hours.
Melatonin release is controlled by circadian rhythms.
This person has a delayed sleep
phase of 2 hours compared to the
normal sleep phase.
Bright light therapy can be used in the morning to treat DSPS.
Advanced Sleep Phase Disorder (ASPD)
A circadian rhythm sleep disorder characterised by an advance in the timing of sleep onset
and wakening.
ASPD is caused by lifestyle factors, genetics, shift work, jetlag, old age etc.
A person’s adverse exposure to light can maintain their undesired advanced circadian
rhythm.
Bright light therapy can be used in the evening to treat ASPD.
This person falls asleep 2 or more
hours earlier than the normal sleep
phase cycle.
Shift work
Disrupts a person’s sleep-wake cycle by putting it in direct opposition to the regular day-night
environmental hours. Shift work can cause a circadian rhythm sleep disorder when a person
regularly works outside of normal business hours.
Bright light therapy
A treatment for circadian rhythm sleep disorders which involves exposing an individual to
light for a specific amount of time to reset the sleep-wake cycle. Exposure to light prompts
the wake-induced biological mechanisms, involving the circadian rhythm and
suprachiasmatic nucleus, to delay melatonin release, promoting wakefulness.
KKDP 6
Improving sleep hygiene and adaptation to zeitgebers to improve sleep-wake patterns
and mental wellbeing, with reference to daylight and blue light, temperature, and eating
and drinking patterns
Diabetes, weight problems, hypertension, cardiovascular disease and mental health
problems such as anxiety disorders are linked to poor sleep (NOT causation).
Sleep hygiene
Sleep-related behaviours and environmental conditions that are beneficial for sleep.
Actions that can improve our bedtime routine:
• Avoid use of devices and caffeine before bed
• Follow a wind-down bedtime routine
• Ensure a cool room temperature and comfortable bedding.
Zeitgebers
Environmental cues that synchronise and regulate the body’s circadian rhythm, such as light,
temperature, and eating and drinking patterns.
Light on sleep
Daylight includes all direct and indirect sunlight during the daytime and is considered the
primary zeitgeber for the human circadian rhythm.
Blue light has the greatest impact on sleep and includes daylight and electronic screen light.
Humans’ access to light has increased over time as we have more access to artificial light
(e.g. phones, TVs, laptops etc) and our exposure to light is no longer just from the sun
(natural light).
Exposure to blue light at the wrong time affects sleep by reducing the quality and quantity of
sleep, therefore contributing to many types of sleep disorders and poor mental and physical
wellbeing.
Ways to avoid too much light at the wrong time:
• Avoid using devices at night
• Reduce screen brightness levels
• Dim room lights.
Graph 1: melatonin levels
remain fairly consistent
throughout the night and
decrease at daytime.
Graph 2: the person likely woke
up and may have scrolled on
their phone around 1am for an
hour and their melatonin levels
decrease significantly, then
increases again when there is
no light present.
Temperature
Body temperature begins to decrease in the early evening, with sleep onset occurring when
core body temperature is at its greatest rate of decline.The lowest body temperature occurs
at about 2 hours after sleep onset. ‘Skin warming’ promotes sleep onset by increasing
blood flow to the skin, resulting in heat loss from the body and body temperature dropping.
Research has found that the ideal room temperature for sleep onset is 19-21°C and ideal
bed microclimate is 31-35°C for people during sleep.
Temperature is on a ‘circadian rhythm’:
This graph represents temperature, melatonin and cortisol levels during the sleep-wake
cycle in adults.A decrease in core body temperature is linked with an increase in melatonin
levels, whichshows that there is a relationship between body temperature and sleep.
Eating and drinking patterns
Mealtime has a larger influence on the sleep-wake cycle than the meal itself as it will get
your body out of sync with the suprachiasmatic nucleus. Food intake follows a timing
(peripheral clock) that isn’t the sleep-wake cycle.
If you eat a large meal at 9/10pm your peripheral clock will be at odds with the
suprachiasmatic nucleus. Peripheral clocks are clocks that regulate our body systems.
Food and meal timing can influence the timing of the peripheral clocks in other organs,
such as the liver and pancreas. This results in these peripheral clocks to become out of sync
with the suprachiasmatic nucleus.
Ways we can improve sleep with diet:
• Limiting caffeine intake later in the day
• Not eating right before bed
• Bringing mealtimes back to a normal
schedule during the active, light phase of the
day.