Sunday, January 22, 2012

Sleep, Circadian Rhythms and Human Behavior

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Sleep, Circadian Rhythms and Human Behavior


Introduction


Sleep is paramount for the human body. At all stages in early human develop-ment and continuing into maturity, sleep provides the human body a needed respite to rejuvenate, to rest, and to energize both mentally and physically. We spend about one-third of our lives asleep. We are all personally aware of our “biological clock.” We know that depriving ourselves of sleep, even for one night, makes us irritable, confused and sometimes delusional. This biological need for sleep is of utmost importance not only in the general physical health, but also is determinate of short and long-term human behavior.


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People who do not get enough sleep report more health problems and have more hospitalizations than people who meet their sleep requirements. This suggests that the loss of sleep in as small as a few hours a night over a period of time impairs or dimin-ishes the functioning of the immune system (Barlow& Durand, 00). It is also recog-nized that sleep disturbances are a hallmark of most mood disorders, especially major depression, bipolar disorder and anxiety-related disorders.


The fact that most people are sensitive to day length at the latitudes they live in suggests that the ‘biological clock” in them controls many physiological aspects such as eating and sleeping, but that any interruption in circadian rhythms is problematic for ge-netic vulnerable individuals and has a correlation to human behavior ( Barlow & Durand, 00).


Scope


Sleep problems in the United States are estimated to cost from $0 to $5 billion per year in lost worker productivity, absenteeism and related outcomes (Chilcott & Shapiro, 16; Walsh & Ustun, 1). We know that adults of all ages average about 7 hours of sleep in every 4-hour period, but that many people are dissatisfied with the amount of sleep they get. In fact, insomnia is a frequent complaint. Almost a third of the general population within the United States report some symptoms of insomnia during any given year (American Psychiatric Association, 000), and 17 percent indicate their problem with sleeping are severe.


Sleep needs change over time and complains of insomnia differ in frequency among people of different ages. Children who have difficulty falling asleep usually tan-trum at bedtime, or do not want to go to bed. Estimates of insomnia among young U.S. children range from 0 to more than 45 percent (Van Tassel, 185). In other countries, specific percentages range from “inadequate sleep” for 0 percent for women over 80 in Norway to “persistent sleep disturbances” for 75 percent of those over age 70 in China (Berger, 001).


Apnea, a breathing-related sleep disorder is thought to occur in 1 to percent of American males, leading to insomnia like symptoms (Barlow & Durand, 00) and po-tential physical and behavioral problems. Sudden infant death syndrome (SIDS) is be-lieved its cause is an unsteady breathing reflex in sleeping children between and 4 months of age (Berger, 001).


Biological Aspects


“Spring forward, fall back” people in most of the United States use this mne-monic device to remind them to turn their clocks forward or backwards one hour in the spring and fall. While this is a minor inconvenience for some because of all the clocks in their lives, it is surprising how disruptive this act is for many individuals. For a least a day or two, they experience sleepy conditions during the day and have difficulty falling asleep at night. The reason for this disruption is not that they gain or lose one hour of sleep; their bodies can adjust to this very quickly. The difficulty has to do with how their “biological clocks” adjust to this change of time. Convention says go to sleep at this new time while their brains are saying something different. If this struggle continues for any length of time, they could develop what is called a circadian rhythm sleep disorder (Bar-low & Durand, 00).


Fortunately, our bodies have mechanisms that continually attempt homeostasis. Our “biological clock” is in the suprachiasmatic nucleus in the hypothalamus. The ability to reset this clock depends upon when light enters the retina and the production of the hormone melatonin by the pineal gland. This gland has greater production of melatonin occurring during night and low production during the day.


Light signals from the retina are conveyed by nerve fibers directly to the su-prachiasmatic nucleus. The suprachiasmatic nucleus transfers information to the hypo-thalamus. After traveling in the spinal cord, the signal reaches the pineal gland. In the absence of a light signal, the gland begins the production of melatonin. When melatonin reaches receptors in the hypothalamus, the body thinks it is dark. Light is the main setter of the human “biological clock”. This sensitivity to light probably evolved over eons of human development, but now researchers believe melatonin influences the time center as well.


Melatonin is of interest because it helps explain the sleep mechanism in our bod-ies. This hormone may help medical and human service professionals treat some of the sleep problems people experience. For example, blind individuals are without clues from the sun, their clocks continually run out of phase. Circadian rhythms for them are reset by giving them melatonin, which tells their brains it is night time even though their eyes cannot determine the time of day.


Winter depression, or seasonal affective disorder (SAD) is thought to occur be-cause of the over production of melatonin. Affecting as much as 5 percent of North Americans in northern latitudes, these individuals tend towards excessive sleep. Mela-tonin is produced only at night and tends to increase in winter when there is less sunlight. This increased production of melatonin might trigger depression in vulnerable people (F.K. Goodwin & Jamison, 10). Some clinicians reasoned that exposure to bright light might slow melatonin production in individuals with SAD (Blehar & Rosenthal, 18). Their efforts have shown that early morning light exposure is superior to evening light exposure due to the fact that morning light produced phase advances of the mela-tonin rhythms. This suggests that returning circadian rhythms to a normal routine are an important factor in treatment not only for SAD, but maybe even effective for nonseasonal depression (Kripe, 18). It is easy to observe that even minor interruptions of sleep rhythms caused by time and seasonal changes have the potential to influence human be-havior. These factors could easily combine with psychological, cognitive, and genetic stressors to dramatically affect behavior, resulting in both acute and chronic progression


Social Work Awareness


Possible circadian rhythms disruptions are difficult to obtain from self-reporting clients. Many individuals believe or rationalize that their present sleep or circadian rhythms are normal. Research has shown that people with sleep and circadian rhythms disruptions have unrealistic expectations about how much sleep they need (“I need a full 8 hours”) and about how disruptive disturbed sleep will be (I won’t be able to think or do my job if I sleep for only 5 hours”) ( Morin, Stone, Trinkle, Mercer, & Remsberg, 1). These studies illuminate the role of cognition in circadian and sleep dysfunctions. Basic concepts of how things should be are influenced by how things were perceived in previ-ous historical contexts. These ideas are based on shared perceptions of a society more than objective reality. This social construction is important because most Americans be-lieve in the 8 hour concept, but completely practice something different.


Social workers should use direct inquires to see if possible sleep disturbances are present that would indicate behavioral complications. Women report insomnia twice as often as men simply because they may be more aware of their sleep patterns than their gender counterpart. As a result, women are diagnosed more with sleep problems.


A sleep problem is only a disorder when the person experiencing it is having dis-comfort over it. A multidimensional view of sleep disorders, whether insomnia or it op-posite hypersomnia, reveals several assumptions The first is that at some level biological, psychological, and cognitive factors are present in most sleep rhythm cases and the sec-ond is that these multiple factors are reciprocally related.


Take the case of Kathryn, who was 7, who re-ported having serious sleep problems ever since her husband died 1 years earlier. She could not fall asleep until she had lain in bed for several hours, and she awakened a number of times each night. She had an average of 4 to 5 hours of broken sleep per night. It is not surprising she was chronically tired throughout the day and complained that fa-tigue interfered with her friendships. She no longer enjoyed going out with her friends because she fell asleep in public, which was very embarrassing to her.


Kathryn used nonprescription sleeping pills on and off over the rears and sometimes she just lay in bed listening to the radio and nodding off occa-sionally. When her sleep problems started, Kath-ryn recognized that her distress over her husband’s death was probably to blame. As the years passed, she assumed poor sleep was normal for a person her age and her fatigue was also part of the aging proc-ess. However, during the past months she began to realize she wasn’t playing with her grandchildren or leaving her house because she was too tired. On the advice of a friend, she decided to get some help (Barlow & Durand).


Kathryn’s treatment involved a multidimensional framework which recognized the need to integrate biological, cognitive and psychological approaches for a successful cure. She first received a regiment of a medicine in the benzodiazepine class. This is recognized to be short-term (four weeks) because of several drawbacks including dependency and re-bound insomnia. Psychological and cognitive treatments were then introduced. She was instructed to limit her time in bed to about fours hours of sleep time (sleep restriction) about the amount of time she actually slept each night. The period was lengthened when she began to sleep through the night. Kathryn was also asked not to listen to the radio while in bed and to get out of bed if she couldn’t fall asleep (stimulus control). Finally, therapy involved confronting her unrealistic expectations about how much sleep was enough for a person of her age (cognitive therapy). Within three weeks of treatment, Kathryn was sleeping longer and had fewer interruptions in her sleep. She felt more re-freshed in the morning and had more energy during the day. Kathryn’s normal activities began to emerge because of the resumption of homeostasis in sleep rhythms (Barlow & Durand). Research suggests that short-term use of medication in combination with other types of interventions may prove to be a quick and lasting treatment for normal human behavioral functioning with regards to sleep and circadian disruptions (Morin & Azrin, 188).


The Issue


A growing number of researchers indicate that American’s sleep problems, such as narcolepsy, apnea, and insomnia, have reached epidemic proportions and may be the country’s number-one health problem (CNN, Aug. 15, 17). The article claims that nearly one-half of all Americans have difficulty sleeping and while this figure may be hard to substantiate, it certainly suggests that the problems of sleep and circadian rhythm disruptions are a serious issue. With the probability that such an issue exists and that it might be of a broader scope than previously imagined, state and federal governments are now turning their attention to the legality of the issue.


State such as California, West Virginia, Florida and Virginia have passed laws covering the issue of sleep deprivation. In a land mark decision, according to The Na-tional Sleep foundation, a Virginia man was sentenced to five years in jail and two years probation after he fell asleep at the wheel after driving for over forty hours. This was the first conviction for sleep deprivation involving a non-commercial driver. The Judge ex-ceeded state sentencing and stated, “If you’re tired and falling asleep as you drive, you need to get off the road. The lesson from this case is you go to jail” (www.voidd.com 7/5/0).


The Federal government is also aware of the issue of sleep deprivation. Statistics compiled for The Federal Motor Carrier Safety Administration shows that 755 fatalities and 1,705 injuries occur each year on the nation’s roads because of drowsy, tired or fa-tigued Commercial Motor Vehicles (CMVs) (DOT, FMCSA, 00). The statistics from the private sector are even greater, with an estimated 100,000 accidents, resulting in a 150,000 injuries and fatalities (www.thehistorychannel.com 7/8/0). The FMCSA re-vise its hours-of-service regulations to require motor carriers to provide drivers with bet-ter opportunities to obtain sleep. One recommendation included the use of electronic on-board recorders used by drivers in long-haul and regional operations in a direct attempt to reduce accidents (http//www.fmcsa.dot.gov/hos/05000p.txt. 7/5/0).


Sleep derivation is as bad as alcohol impairment. Some tests shows that indi-viduals who drive after being awake for 17 to 1 hours preformed worse than those with blood alcohol count of .05 (CNN, Sept. 0, 000). These figures have further implica-tions than for just drivers. People who work long shifts or night shifts, such as medical personnel or other emergency workers, may also have troubles.


Information Themes


There has always been some interest in sleep among health professionals. Freud was extremely interested in dream analysis, but little was really accomplished in the study of sleep until the last fifteen to twenty years. More and more research is being conducted with emphasis toward understanding the correlation of sleep towards human behavior and general health, but judging from the tremendous scope of the issue and how it crosses all gender, ages and class, research efforts have barely touched the subject.


Even though this is true, research psychologists are the leaders among the health professions. Even if a person suspects a problem with circadian rhythms and seeks medi-cal advice, it can be difficult to find a doctor who understands sleep disorders because most medical schools don’t offer courses on sleep. There is an extreme lack of commu-nity resources addressing these issues. This is particularly worrisome for individuals in rural areas which have higher rates of suicide. Correlations between higher suicide rates and sleep cycles have not been researched specifically, but most professionals logically conclude there is a connection.


National organizations such as the National Sleep Foundation maintain excellent web sites. This organization offers a broad range of information for lay persons seeking information on the possibility of having sleep disorders. There is a sleep test that can be taken to determine the possibility of sleep disorders and a list of sleep laboratories in their area. While this information is available for all people, professional care givers should rely on more technical information. What information is available is readily accessible with a subject search into most psychological libraries. Researchers should expect a cer-tain degree of vagueness about specific issues regarding human behavior and sleep cycles and may have to synthesize information to extract the needed material for intervention.


Recommendations


As pointed out in the awareness portion of this document, most people will not seek professional help simply because they are not sleeping well. They will only venture forth towards treatment because of the presence of other problems. Therefore, we would often think of intervention for them originating towards the person, but to be truly a to-tally effective intervention, social workers should consider moving past the Microsystems of the individual and into the surrounding Ecosystems. With the high estimated cost to employers due to lost worker productivity and absenteeism, employers should welcome seminars and instructional sessions designed to help make their employees become aware of how to change lifestyles that will improve their sleeping habits, their general health, and as a result, cut costs for the employer. These recommendations to improve sleeping hygiene could be carried into high risk areas of long distance drivers and emergency per-sonnel and other occupational shift workers. Sleep hygiene recommendations could be introduced into schools and parent groups to improve sleeping habits among children. Because so many children display disruptive sleep problems, this type of preventive ef-fort could serve to improve significantly the lives of many families. Similar preventative methods to educate the general public could reduce the amount of lives and property lost due to driving accidents while sleepy. Education could change the social construction of how vulnerable individuals are when they disrupt normal sleep and circadian rhythms.


Until such social constructions could be changed, it is paramount for social work-ers and clinicians to be aware that when clients come to them with a self-perceived prob-lem of depression, anxiety or other mood disorder, intervention assessment must take into consideration that resumption of normal sleep patterns must be a part of overall treatment. They should understand the importance of sleep and circadian rhythms to the overall suc-cess of any treatment. As a part of a physical examination, clinicians might recommend the use of sleep laboratories to gain valuable information about the sleeping habits of the individual and ultimately clues to his or her unique behavior. Other clues to sleep rhythms and behavior could be obtained by occupational screening. Chances are greater for behavioral deviation in workers who are in high risk occupations.


We observe that human behavior is affected by the lack of sleep. That deficiency causes a range of behavior from abnormal, to criminally negligent, and in Kathryn’s case, to simple isolation. We see that the scope of the issue is enormous, and that sleep dys-functions are most likely epidemic in the United States and prevalent in the entire world. We note that research is continuing and advancing knowledge about specifics, but much remains to be discovered. Americans are concerned about their sleep, with probably ex-plains why billion of dollars are invested in bed mattresses with the promise of better sleep, but they often exhibit cognitive errors about sleep. Social workers, clinicians, and other health care professional must recognize the biological, psychological, and cognitive aspects of sleep deprivation and its direct correlation to human behavior.








Glossary


Apnea Brief interruption in breathing, sometimes occurring during sleep.


Circadian rhythm Biological rhythm with a 4-hours cycle.


Circadian rhythm sleep disorder Sleep disturbance resulting in sleepiness or insomnia caused by the body’s inability to synchronize its sleep pattern with the current pattern of day and night.


Cognitive therapy Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depression and anxiety and re-placing them with more positive beliefs and attitudes�and, ultimately, more adaptive behavior and coping styles.


Hypothalamus Part of the diencephalon of the brain broadly involved in the regulation of behavior and emotion.


Insomnia Difficulty falling asleep, staying asleep, or feeling rested where there is no apparent medical or psychological cause.


Melatonin Hormone produced by the pineal gland that is activated by darkness to con-trol the body’s biological clock and to induce sleep. It is implicated in seasonal affective disorder and may be used in treatments for circadian rhythm sleep disorders.


Narcolepsy Sleep disorder involving sudden and irresistible sleep attacks.


Pineal Gland Endocrine gland located in the third ventricle of the brain that produces melatonin.


Seasonal Affective Disorder (SAD) Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter.


Sleep hygiene Psychological treatment for insomnia that teaches clients to recognize and eliminate environmental obstacles to sleep. These include the use of nicotine, caf-feine, and certain medications, and alcohol as well as ill-timed exercise.


Sleep restriction Treatment for insomnia that involves limiting time in bed to the actual amount spent sleeping so that the bed is associated with sleep and no other competing activities.


Stimulus control Deliberate arrangement of the environment so it encourages desired behaviors and discourages problem behavior. For example, insomnia may be combated by limiting time in and associations with, the bed.


References


American Psychiatric Association (000)


Practice guidelines for the treatment of patients with Alzheimer’s disease and other dementias of late life Compendium 000 (pp.6-17) Washington, DC.


Barlow, D. H., & Durand, M. V., (00)


Abnormal Psychology an integrative approach Sleep Disorders 00 (pp.1-


68) Belmont, CA.


Berger, K. S., (001)


The Developing Person through the Life Span (pp.1-66)


Worth Publishers, New York, NY.


Blehar, M.C., & Rosenthal, N.E. (18)


Seasonal affective disorder and phototherapy. Archives of General Psychiatry, 46, (pp. 46-474).


Chilcott, L. A., & Shapiro, C. M. (16)


The socioeconomic impact of insomnia An overview, Pharmacoeconomics, 10,


(pp 1-14).


Goodwin, F.K., & Jamison, K, R. (10)


Manic Depressive Illness (pp. 16-161) Oxford University Press, New York


Kripe, D. F. (18)


Light treatment for nonseasonal depression Speed, efficiency, and combined


Treatment. Journal of Abnormal Psychology, 105, (pp. 10-117).


Mader, S. S. (00)


Human Biology (p 08) McGraw-Hill, New York, NY.


Morin, C. M., & Azrin, N. H. (188)


Behavioral and cognitive treatments of geriatric insomnia. Journal of Consulting


and Clinical Psychology, 56, (pp.748-75).


Morin, C. M., Stone, J., Trinkle, D., Mercer, J., & Remsberg, S. (1)


Dysfunctional beliefs and attitudes about sleep among older adults with and


without insomnia complaints. Psychology and Aging, 8, (pp. 46-467).


Van Tassel, E. B. (185)


The relative influence of child and environmental characteristics on sleep


disturbances in the first and second years of life. Journal of Developmental


and Behavioral Pediatrics, 6, (pp.81-85).


http//www.cnn.com/HEALTH/70/17/wfm/deprivation/index.htm. 07/5/0.


http//www.cnn.com/000/HEALTH/0/0//sleep. deprivation/ 07/5/0.


http//www.thehistorychannel.com 07/6/0.


http//www.voidd.com 07/5/0.





Sleep, Circadian Rhythms and Human Behavior


Introduction


Sleep is paramount for the human body. At all stages in early human develop-ment and continuing into maturity, sleep provides the human body a needed respite to rejuvenate, to rest, and to energize both mentally and physically. We spend about one-third of our lives asleep. We are all personally aware of our “biological clock.” We know that depriving ourselves of sleep, even for one night, makes us irritable, confused and sometimes delusional. This biological need for sleep is of utmost importance not only in the general physical health, but also is determinate of short and long-term human behavior.


People who do not get enough sleep report more health problems and have more hospitalizations than people who meet their sleep requirements. This suggests that the loss of sleep in as small as a few hours a night over a period of time impairs or dimin-ishes the functioning of the immune system (Barlow& Durand, 00). It is also recog-nized that sleep disturbances are a hallmark of most mood disorders, especially major depression, bipolar disorder and anxiety-related disorders.


The fact that most people are sensitive to day length at the latitudes they live in suggests that the ‘biological clock” in them controls many physiological aspects such as eating and sleeping, but that any interruption in circadian rhythms is problematic for ge-netic vulnerable individuals and has a correlation to human behavior ( Barlow & Durand, 00).


Scope


Sleep problems in the United States are estimated to cost from $0 to $5 billion per year in lost worker productivity, absenteeism and related outcomes (Chilcott & Shapiro, 16; Walsh & Ustun, 1). We know that adults of all ages average about 7 hours of sleep in every 4-hour period, but that many people are dissatisfied with the amount of sleep they get. In fact, insomnia is a frequent complaint. Almost a third of the general population within the United States report some symptoms of insomnia during any given year (American Psychiatric Association, 000), and 17 percent indicate their problem with sleeping are severe.


Sleep needs change over time and complains of insomnia differ in frequency among people of different ages. Children who have difficulty falling asleep usually tan-trum at bedtime, or do not want to go to bed. Estimates of insomnia among young U.S. children range from 0 to more than 45 percent (Van Tassel, 185). In other countries, specific percentages range from “inadequate sleep” for 0 percent for women over 80 in Norway to “persistent sleep disturbances” for 75 percent of those over age 70 in China (Berger, 001).


Apnea, a breathing-related sleep disorder is thought to occur in 1 to percent of American males, leading to insomnia like symptoms (Barlow & Durand, 00) and po-tential physical and behavioral problems. Sudden infant death syndrome (SIDS) is be-lieved its cause is an unsteady breathing reflex in sleeping children between and 4 months of age (Berger, 001).


Biological Aspects


“Spring forward, fall back” people in most of the United States use this mne-monic device to remind them to turn their clocks forward or backwards one hour in the spring and fall. While this is a minor inconvenience for some because of all the clocks in their lives, it is surprising how disruptive this act is for many individuals. For a least a day or two, they experience sleepy conditions during the day and have difficulty falling asleep at night. The reason for this disruption is not that they gain or lose one hour of sleep; their bodies can adjust to this very quickly. The difficulty has to do with how their “biological clocks” adjust to this change of time. Convention says go to sleep at this new time while their brains are saying something different. If this struggle continues for any length of time, they could develop what is called a circadian rhythm sleep disorder (Bar-low & Durand, 00).


Fortunately, our bodies have mechanisms that continually attempt homeostasis. Our “biological clock” is in the suprachiasmatic nucleus in the hypothalamus. The ability to reset this clock depends upon when light enters the retina and the production of the hormone melatonin by the pineal gland. This gland has greater production of melatonin occurring during night and low production during the day.


Light signals from the retina are conveyed by nerve fibers directly to the su-prachiasmatic nucleus. The suprachiasmatic nucleus transfers information to the hypo-thalamus. After traveling in the spinal cord, the signal reaches the pineal gland. In the absence of a light signal, the gland begins the production of melatonin. When melatonin reaches receptors in the hypothalamus, the body thinks it is dark. Light is the main setter of the human “biological clock”. This sensitivity to light probably evolved over eons of human development, but now researchers believe melatonin influences the time center as well.


Melatonin is of interest because it helps explain the sleep mechanism in our bod-ies. This hormone may help medical and human service professionals treat some of the sleep problems people experience. For example, blind individuals are without clues from the sun, their clocks continually run out of phase. Circadian rhythms for them are reset by giving them melatonin, which tells their brains it is night time even though their eyes cannot determine the time of day.


Winter depression, or seasonal affective disorder (SAD) is thought to occur be-cause of the over production of melatonin. Affecting as much as 5 percent of North Americans in northern latitudes, these individuals tend towards excessive sleep. Mela-tonin is produced only at night and tends to increase in winter when there is less sunlight. This increased production of melatonin might trigger depression in vulnerable people (F.K. Goodwin & Jamison, 10). Some clinicians reasoned that exposure to bright light might slow melatonin production in individuals with SAD (Blehar & Rosenthal, 18). Their efforts have shown that early morning light exposure is superior to evening light exposure due to the fact that morning light produced phase advances of the mela-tonin rhythms. This suggests that returning circadian rhythms to a normal routine are an important factor in treatment not only for SAD, but maybe even effective for nonseasonal depression (Kripe, 18). It is easy to observe that even minor interruptions of sleep rhythms caused by time and seasonal changes have the potential to influence human be-havior. These factors could easily combine with psychological, cognitive, and genetic stressors to dramatically affect behavior, resulting in both acute and chronic progression


Social Work Awareness


Possible circadian rhythms disruptions are difficult to obtain from self-reporting clients. Many individuals believe or rationalize that their present sleep or circadian rhythms are normal. Research has shown that people with sleep and circadian rhythms disruptions have unrealistic expectations about how much sleep they need (“I need a full 8 hours”) and about how disruptive disturbed sleep will be (I won’t be able to think or do my job if I sleep for only 5 hours”) ( Morin, Stone, Trinkle, Mercer, & Remsberg, 1). These studies illuminate the role of cognition in circadian and sleep dysfunctions. Basic concepts of how things should be are influenced by how things were perceived in previ-ous historical contexts. These ideas are based on shared perceptions of a society more than objective reality. This social construction is important because most Americans be-lieve in the 8 hour concept, but completely practice something different.


Social workers should use direct inquires to see if possible sleep disturbances are present that would indicate behavioral complications. Women report insomnia twice as often as men simply because they may be more aware of their sleep patterns than their gender counterpart. As a result, women are diagnosed more with sleep problems.


A sleep problem is only a disorder when the person experiencing it is having dis-comfort over it. A multidimensional view of sleep disorders, whether insomnia or it op-posite hypersomnia, reveals several assumptions The first is that at some level biological, psychological, and cognitive factors are present in most sleep rhythm cases and the sec-ond is that these multiple factors are reciprocally related.


Take the case of Kathryn, who was 7, who re-ported having serious sleep problems ever since her husband died 1 years earlier. She could not fall asleep until she had lain in bed for several hours, and she awakened a number of times each night. She had an average of 4 to 5 hours of broken sleep per night. It is not surprising she was chronically tired throughout the day and complained that fa-tigue interfered with her friendships. She no longer enjoyed going out with her friends because she fell asleep in public, which was very embarrassing to her.


Kathryn used nonprescription sleeping pills on and off over the rears and sometimes she just lay in bed listening to the radio and nodding off occa-sionally. When her sleep problems started, Kath-ryn recognized that her distress over her husband’s death was probably to blame. As the years passed, she assumed poor sleep was normal for a person her age and her fatigue was also part of the aging proc-ess. However, during the past months she began to realize she wasn’t playing with her grandchildren or leaving her house because she was too tired. On the advice of a friend, she decided to get some help (Barlow & Durand).


Kathryn’s treatment involved a multidimensional framework which recognized the need to integrate biological, cognitive and psychological approaches for a successful cure. She first received a regiment of a medicine in the benzodiazepine class. This is recognized to be short-term (four weeks) because of several drawbacks including dependency and re-bound insomnia. Psychological and cognitive treatments were then introduced. She was instructed to limit her time in bed to about fours hours of sleep time (sleep restriction) about the amount of time she actually slept each night. The period was lengthened when she began to sleep through the night. Kathryn was also asked not to listen to the radio while in bed and to get out of bed if she couldn’t fall asleep (stimulus control). Finally, therapy involved confronting her unrealistic expectations about how much sleep was enough for a person of her age (cognitive therapy). Within three weeks of treatment, Kathryn was sleeping longer and had fewer interruptions in her sleep. She felt more re-freshed in the morning and had more energy during the day. Kathryn’s normal activities began to emerge because of the resumption of homeostasis in sleep rhythms (Barlow & Durand). Research suggests that short-term use of medication in combination with other types of interventions may prove to be a quick and lasting treatment for normal human behavioral functioning with regards to sleep and circadian disruptions (Morin & Azrin, 188).


The Issue


A growing number of researchers indicate that American’s sleep problems, such as narcolepsy, apnea, and insomnia, have reached epidemic proportions and may be the country’s number-one health problem (CNN, Aug. 15, 17). The article claims that nearly one-half of all Americans have difficulty sleeping and while this figure may be hard to substantiate, it certainly suggests that the problems of sleep and circadian rhythm disruptions are a serious issue. With the probability that such an issue exists and that it might be of a broader scope than previously imagined, state and federal governments are now turning their attention to the legality of the issue.


State such as California, West Virginia, Florida and Virginia have passed laws covering the issue of sleep deprivation. In a land mark decision, according to The Na-tional Sleep foundation, a Virginia man was sentenced to five years in jail and two years probation after he fell asleep at the wheel after driving for over forty hours. This was the first conviction for sleep deprivation involving a non-commercial driver. The Judge ex-ceeded state sentencing and stated, “If you’re tired and falling asleep as you drive, you need to get off the road. The lesson from this case is you go to jail” (www.voidd.com 7/5/0).


The Federal government is also aware of the issue of sleep deprivation. Statistics compiled for The Federal Motor Carrier Safety Administration shows that 755 fatalities and 1,705 injuries occur each year on the nation’s roads because of drowsy, tired or fa-tigued Commercial Motor Vehicles (CMVs) (DOT, FMCSA, 00). The statistics from the private sector are even greater, with an estimated 100,000 accidents, resulting in a 150,000 injuries and fatalities (www.thehistorychannel.com 7/8/0). The FMCSA re-vise its hours-of-service regulations to require motor carriers to provide drivers with bet-ter opportunities to obtain sleep. One recommendation included the use of electronic on-board recorders used by drivers in long-haul and regional operations in a direct attempt to reduce accidents (http//www.fmcsa.dot.gov/hos/05000p.txt. 7/5/0).


Sleep derivation is as bad as alcohol impairment. Some tests shows that indi-viduals who drive after being awake for 17 to 1 hours preformed worse than those with blood alcohol count of .05 (CNN, Sept. 0, 000). These figures have further implica-tions than for just drivers. People who work long shifts or night shifts, such as medical personnel or other emergency workers, may also have troubles.


Information Themes


There has always been some interest in sleep among health professionals. Freud was extremely interested in dream analysis, but little was really accomplished in the study of sleep until the last fifteen to twenty years. More and more research is being conducted with emphasis toward understanding the correlation of sleep towards human behavior and general health, but judging from the tremendous scope of the issue and how it crosses all gender, ages and class, research efforts have barely touched the subject.


Even though this is true, research psychologists are the leaders among the health professions. Even if a person suspects a problem with circadian rhythms and seeks medi-cal advice, it can be difficult to find a doctor who understands sleep disorders because most medical schools don’t offer courses on sleep. There is an extreme lack of commu-nity resources addressing these issues. This is particularly worrisome for individuals in rural areas which have higher rates of suicide. Correlations between higher suicide rates and sleep cycles have not been researched specifically, but most professionals logically conclude there is a connection.


National organizations such as the National Sleep Foundation maintain excellent web sites. This organization offers a broad range of information for lay persons seeking information on the possibility of having sleep disorders. There is a sleep test that can be taken to determine the possibility of sleep disorders and a list of sleep laboratories in their area. While this information is available for all people, professional care givers should rely on more technical information. What information is available is readily accessible with a subject search into most psychological libraries. Researchers should expect a cer-tain degree of vagueness about specific issues regarding human behavior and sleep cycles and may have to synthesize information to extract the needed material for intervention.


Recommendations


As pointed out in the awareness portion of this document, most people will not seek professional help simply because they are not sleeping well. They will only venture forth towards treatment because of the presence of other problems. Therefore, we would often think of intervention for them originating towards the person, but to be truly a to-tally effective intervention, social workers should consider moving past the Microsystems of the individual and into the surrounding Ecosystems. With the high estimated cost to employers due to lost worker productivity and absenteeism, employers should welcome seminars and instructional sessions designed to help make their employees become aware of how to change lifestyles that will improve their sleeping habits, their general health, and as a result, cut costs for the employer. These recommendations to improve sleeping hygiene could be carried into high risk areas of long distance drivers and emergency per-sonnel and other occupational shift workers. Sleep hygiene recommendations could be introduced into schools and parent groups to improve sleeping habits among children. Because so many children display disruptive sleep problems, this type of preventive ef-fort could serve to improve significantly the lives of many families. Similar preventative methods to educate the general public could reduce the amount of lives and property lost due to driving accidents while sleepy. Education could change the social construction of how vulnerable individuals are when they disrupt normal sleep and circadian rhythms.


Until such social constructions could be changed, it is paramount for social work-ers and clinicians to be aware that when clients come to them with a self-perceived prob-lem of depression, anxiety or other mood disorder, intervention assessment must take into consideration that resumption of normal sleep patterns must be a part of overall treatment. They should understand the importance of sleep and circadian rhythms to the overall suc-cess of any treatment. As a part of a physical examination, clinicians might recommend the use of sleep laboratories to gain valuable information about the sleeping habits of the individual and ultimately clues to his or her unique behavior. Other clues to sleep rhythms and behavior could be obtained by occupational screening. Chances are greater for behavioral deviation in workers who are in high risk occupations.


We observe that human behavior is affected by the lack of sleep. That deficiency causes a range of behavior from abnormal, to criminally negligent, and in Kathryn’s case, to simple isolation. We see that the scope of the issue is enormous, and that sleep dys-functions are most likely epidemic in the United States and prevalent in the entire world. We note that research is continuing and advancing knowledge about specifics, but much remains to be discovered. Americans are concerned about their sleep, with probably ex-plains why billion of dollars are invested in bed mattresses with the promise of better sleep, but they often exhibit cognitive errors about sleep. Social workers, clinicians, and other health care professional must recognize the biological, psychological, and cognitive aspects of sleep deprivation and its direct correlation to human behavior.








Glossary


Apnea Brief interruption in breathing, sometimes occurring during sleep.


Circadian rhythm Biological rhythm with a 4-hours cycle.


Circadian rhythm sleep disorder Sleep disturbance resulting in sleepiness or insomnia caused by the body’s inability to synchronize its sleep pattern with the current pattern of day and night.


Cognitive therapy Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depression and anxiety and re-placing them with more positive beliefs and attitudes�and, ultimately, more adaptive behavior and coping styles.


Hypothalamus Part of the diencephalon of the brain broadly involved in the regulation of behavior and emotion.


Insomnia Difficulty falling asleep, staying asleep, or feeling rested where there is no apparent medical or psychological cause.


Melatonin Hormone produced by the pineal gland that is activated by darkness to con-trol the body’s biological clock and to induce sleep. It is implicated in seasonal affective disorder and may be used in treatments for circadian rhythm sleep disorders.


Narcolepsy Sleep disorder involving sudden and irresistible sleep attacks.


Pineal Gland Endocrine gland located in the third ventricle of the brain that produces melatonin.


Seasonal Affective Disorder (SAD) Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter.


Sleep hygiene Psychological treatment for insomnia that teaches clients to recognize and eliminate environmental obstacles to sleep. These include the use of nicotine, caf-feine, and certain medications, and alcohol as well as ill-timed exercise.


Sleep restriction Treatment for insomnia that involves limiting time in bed to the actual amount spent sleeping so that the bed is associated with sleep and no other competing activities.


Stimulus control Deliberate arrangement of the environment so it encourages desired behaviors and discourages problem behavior. For example, insomnia may be combated by limiting time in and associations with, the bed.


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