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Sleep, Memory, and

Recovery
Instructor: Anita McCrary

Sleep, Memory, and Recovery


Outline
I. The Need for Sleep
II. Hormones, Sleep and Behavior
III. Sleep Spindles and Memory Foundation
IV. The Effects of Sleep Deprivation
V. Sleep and SUDs Recovery
VI. Case Study
VII. Exam
VIII. References

The Need for Sleep


This course reviews the fundamentals of sleep and the psychophysiological effects of sleep deprivation. The
course content is oriented to counselors and therapists working in clinical settings such as: marriage and family
therapy, substance abuse, and first response healthcare professionals. The objective of the course is to educate
clinical professionals on the psychological effects of sleep deprivation and why sleep should be the fundamental
first step in any clinical recovery plan.

Key Concepts:
Completion of the course equips the clinician with the knowledge of:
How hormones affect sleep-wake cycles
How sleep deprivation effects behavior
Why sleep should be the fundamental first step in any clinical recovery plan

The National Sleep Foundation recommends the average healthy adult receive 7-9 hours of uninterrupted sleep
per 24-hour period. Since 2004, the National Sleep Awareness Roundtable (NSART) has made a concerted
effort to advance and educate the public on the health and safety risks associated with sleep deprivation. The
2013 multi-state report, Drowsy Driving: 19 States and the District of Columbia, 2009-2010 (Wheaton, 2013), the
largest to date, reveals the grim prevalence of sleep deprivation in the United States. The CDC report finds young
minority men driving drowsy more than women of any ethnicity, with confessors allowing themselves less than
six hours of sleep a night. There are serious health effects associated with sleep deprivation, including the deadly
triad of cardiovascular-diabetes-cancer (Nieto, 2012) (Levy, 2012). The cognitive effects of a 24-hour waking state
are the same as a blood alcohol content of .8-1.0 mg/mL (Ramaekers, 2012). Clinicians should integrate sleep
questionnaires as a pre-screening tool prior to assessing and applying other therapeutic measures in intervention
and recovery.

Sleep, Memory, and Recovery


Hormones, Sleep and Behavior
Hormone balance influences brain function in two ways:
organizational and activational (Arnold, 1984). Hormones
organize regions of the brain by binding to DNA and
respond accordingly. Gender differences in genetic
transcription take place in the area of the brain controlling
emotional behavior and the daily sleep cycle. As stress
levels go up, the male brain typically activates and the
female brain typically becomes dysfunctional. This helps
explain behaviors such as pacing, screaming, crying,
or physical force in times of stress. A man will typically
search for the source of the problem (Mr. Fix-it), whereas Sample EEG of Sleep Spindle and K-Complex (sccpsy101.com)
a female cries (Miss Emotional). This also helps to
explain the sexually dimorphic BMI ratio differences in the Spindles also effect memory consolidation and learning
sexes. Body fat correlates with estrogen presence in the behavior (Warby, 2012). As spindle waves spike, short-
bloodstream. Because females possess more estrogen, term memories are categorically placed into long-term
her BMI is higher than her male counterpart. Testosterone- memory. Each spindle spike repeats the information
rich male cells build muscle mass whereas estrogen-rich placement, just as each circulation of the fan blade forces
female cells become engorged. the air forward. Each rotation creates stronger memory
consolidation. A restriction in spindle waves means a loss
Cortisol is a protein and carbohydrate metabolizer; the of information consolidation. Estrogen-rich females exhibit
mass behind the muscle and the fuel for fight or flight. twice the number of sleep spindles as men (Gillard, 1981).
The presence of cortisol in the bloodstream is similar Perhaps this is the crux of the old argument between men
to the electrical voltage within your home. Where some and women and the ability to remember incidental things
circuits require 110 volts (i.e. a lamp, television, clock (she remembers everything; he remembers nothing).
radio), others require 220 volts (i.e. a refrigerator or stove). Fewer spindle oscillations severely inhibits a persons
Females require less voltage (cortisol) than males. When ability to apply what they know to active situations.
the voltage (cortisol) exceeds requirements, the electrical Disruptions in spindle oscillations (or stopping the
system (the brain) trips, systems malfunction or completely circulation of the fan blades) halts the categorization of
break down. Similar to an electrical circuit breaker, short-term memories into these categories.
hormones act like electrical currents energizing arousal
and lower levels initiate sleep through a careful balance Consider Wilson and Beards learning combination lock
of cortisol and estrogen during a 24-hour circadian (sleep) (Wilson, 2003), which explains how the brain matches
cycle (Arnold, 1984; Romeo, 2004). Peak cortisol levels current memories to long-term categories. Spindles
around 9:00 a.m. will begin to diminish and bottom out oscillate (number wheel) and match external elements
around midnight. Think of it as a glass of water with a tiny with a unique internal category (wheels). Each spindle
hole in the bottom. As more time passes, there is less oscillation match active stimuli (conscious or unconscious)
water in the glass. Less cortisol creates sleepiness. and long-term schemas in a particular order: (1) external
elements in the environment, (2) sensory (i.e. smells,
sights, etc.), and (3) individual schemas.
Sleep Spindles and Memory
Formation
At its lowest level, cortisol initiates sleep spindle waves
(or brain waves) throughout the front and central brain
regions, blocking sensory information during sleep
(Yamadori, 1971), (Dang-Vu, 2010) and (De Gennaro,
2003). Sleep spindles make the conscious world go away.
Think of sleep spindles as the blades of a fan. As the
fan blade slices through the air, it makes noise (swoosh)
and forces air outward. Body fat, and therefore estrogen,
increase sleep spindles. Perhaps this is natures way
of compensating the female for sleep disruptions when
caring for newborn children, and why it is vital for a new
mother to nap when her baby naps.

Sleep, Memory, and Recovery


Like a highway crew resurfacing a road, each spindle The zeal in sleep research within the past decade compels
oscillation repaves the memory road, creating a stronger, clinicians to screen for sleep deprivation at the onset of
smoother road for a person to remember previous therapeutic intervention and recovery. Kahn-Green found
learning. Sleep spindles turn a gravel road into a sleep deprivation causes feelings of persecution and
super highway. This is why children and adolescents perception of unfair treatment by others, including greater
require 8-10 hours of sleep a night. During this stage resentment, sensitivity to perceived insults/slights, and
of development, the child is learning massive amounts projection of blame onto others (Kahn-Greene, 2007,
of information and they can only retain this knowledge p. 219). Sleep deprivation impairs a persons ability
through adequate sleep. to compromise or rationalize in an emotionally-driven
situation. Deprivation of sleep exaggerates anticipatory
Have you ever wondered why some things are more activity and interpersonal disassociation, causing feelings
important than others and why there are so many of powerlessness, inadequacy, worthlessness, failure,
individual differences? According to Perogamvros, and self-doubt (Goldstein, 2012). It causes a person
individuals prioritize information according to a persons to react defensively and harshly before considering
genetics and moral values. Perogamvros Reward other variables. For example, in Go/NoGo shooting
Activation Model (RAM) also gives us an explanation for scenarios, night shift police officers show a decrease
the pathogenesis of substance abuse (Perogamvros, in ability to distinguish threatening and non-threatening
2012). The RAM theory centers on the brains reward scenarios, trending toward an increase in shooting rates
pathway and prioritizes emotional and motivational in non-threatening scenarios (Waggoner, 2012). Sleep
information. The model suggests an individuals brain deprivation compels a person to shoot first and ask
labels certain things important, increasing the circulation questions later.
frequency during sleep and while dreaming. The higher
the reward value the more often the information circulates
during spindle spikes.

The Effects of Sleep Deprivation

The only time a person gains from sleep deprivation


is immediately after a traumatic event and may thwart
PTSD (Cohen, 2012). The reactivity to emotionally
charged situations affects the consolidation of memories.
By postponing sleep after trauma, consolidation of the
traumatic event into long-term memory is postponed,
Reward thresholds by type resetting the brain to its natural, or homeostasis, form
(www.yourbrainonporn.com) (Cohen, 2012). Cortisol positively influences certain brain
areas in men and negatively influences women. When
Sleep deprivation reduces connectivity and causes cortisol levels are high, males rationalize the stimuli
dysfunctional emotional control, inadequate coping abilities, quicker and faster than women (Jackson, 2006)
and increases risk-taking behavior. The system needs time (Zorawski, 2006). This could possibly explain a mans
to compare actual events to existing memories. This can instinctual need to guard and protect; he must pay
only occur during sleep. Sleep deprivation further hastens attention during a threat.
a persons ability to control an emotional response. Without
the proper amount of sleep, the brain reduces the number
of spindle oscillations made in the process of information
consolidation. Just as the fan cools the air, sleep cools the
emotional attachment of a situation.

Sleep, Memory, and Recovery


Sleep and SUDs Recovery officers sniveling, jealous, wanna-be cops. The lieutenant
administers Charlie a verbal warning to lose his bad
An inventory of sleeping habits should be a fundamental attitude and to get his head back into the game.
first step in any clinical recovery plan. Quick self-report
sleep assessments, such as the MCG Health or the Palo Leaving the police station, Charlie stops at a local
Alto Medical Foundation Sleep Wake Questionnaire, convenience store and buys two energy supplements and
provide a solid foundation for further treatment planning. drinks them both. Twenty minutes later, Charlies hands
More in-depth assessments such as the Iowa Sleep begin to tremble and he begins to feel a tightening in
Disturbances Inventory measure unusual sleep his chest. He pulls into a parking lot for a few moments
experiences associated with schizotypy and PTSD. and the tightening subsides. Later in the evening, the
Stabilizing these mechanisms may omit the need for dispatcher radios a domestic violence call and Charlie
pharmaceutical interventions for anxiety and avoids speeds through the busy downtown streets of Atlanta,
unnecessary side effects of medication. forgetting to switch on his siren and lights. As he
approaches a red traffic light he does not see an oncoming
Arming the client with the knowledge regarding the civilian driver and his cruiser slams into the rear corner-
effects of sleep deprivation and integrating it into therapy panel of the car. The civilian driver loses control, directing
empowers and motivates ongoing therapy. As the client the car into a parking lot filled with other cars. When
experiences improvements in vitality and resiliency, Charlies cruiser comes to rest on a city sidewalk, the
follow-up therapy becomes more robust and reliable. tightening in his chest becomes an excruciating pain. The
Nothing motivates change more than the positive results domestic violence call results in a drunken father shooting
of adequate sleep. his gang-banger son. Charlie awakes the next day in the
hospital where a doctor informs him he has had a mild
CASE STUDY heart attack.

This story reflects the devastating effects of sleep


Charlie is a 29-year old African-American police detective
deprivation. After 24 hours, Charlies cognitive ability to
for the City of Atlanta. Charlie has a vibrant personality
effectively serve and protect the citizens of Atlanta suffers
and is well-liked among his peers. He has received several
dramatic consequences. He tries to compensate for his
awards and accommodations for his police work. Recent
sleep deprivation by consuming large amounts of caffeine.
budget cuts in the police department have extended shifts
The extreme levels of caffeine and anxiety increases
from 10 to 12 hour days. In July, several officers take
the amount of cortisol in his bloodstream, exacerbating
vacation leave and Charlie volunteers to cover the absent
natural cell death and causing irreparable damage to his
officers shifts. He is enthusiastic about the overtime pay
heart muscle. Charlies normal temperament radically
because he is saving money to buy his first home. For two
changes; he can no longer drive safely or rationalize
weeks, Charlie works double shifts, keeping him awake for
effectively. Charlies dysfunctional performance leads to
24-hour and sometimes 48-hours at a time.
several lawsuits filed against the city because of the traffic
On Charlies 15th day of duty, he reports to his precinct accident. Also, a teenager dies because Charlie could
and his lieutenant calls him into his office, informing not respond to the domestic violence call. Finally, a long
Charlie there have been several complaints from other hospitalization depletes Charlies savings, he must file for
officers regarding Charlies poor performance and quick medical bankruptcy, and he loses the ability to buy his
temper. Charlie reacts defensively and calls the other first home.

Sleep, Memory, and Recovery


Exam
1. Sleep deprivation effects: 6. Who benefits more from the release of cortisol into the
a. Driving bloodstream?
b. Interpersonal Relationships g. Males
c. Emotions h. Females
d. All of the Above i. Both males and females
j. Neither males nor females
2. At optimal levels, a person is awake and alert; at
minimal levels, a person is sleepy due to: 7. The only time sleep deprivation can be of assistance is:
a. Testosterone a. When a female is a new mother.
b. Cortisol b. When a person is snoring.
c. Estrogen c. After trauma.
d. Sleep spindles d. When a woman is hoping to conceive.
3. Children and adolescents require this much sleep in a 8. Receiving 7-9 hours of sleep in a 24-hour period is
24-hour period: shown to help:
a. 6-8 hours of sleep a. Infection
b. 7-9 hours of sleep b. Menstrual cramps
c. 8-10 hours of sleep c. Remembering peoples names
d. 10 or more hours of sleep. d. Drunk driving
4. Prolonging wakefulness can: 9. According to the National Sleep Foundation, the
a. Make a person feel like a victim average healthy adult should receive how many hours
of uninterrupted sleep in a 24-hour period?
b. Cause traffic accidents
a. 6-7 hours
c. Shoot someone
b. 7-9 hours
d. All of the Above
c. 8-10 hours
5. According to the RAM theory, the higher the reward d. 4-7 hours
value of a stimuli:
a. the more you push the circadian clock. 10. The cognitive effects of a 24-hour waking state are the
same as:
b. the more the memory circulates during sleep.
a. an electrical circuit
c. metabolism increases.
b. memory loss
d. The more sleep spindles produced.
c. being legally drunk
d. the sound a fan blade makes when slicing
through the air

Sleep, Memory, and Recovery


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Sleep, Memory, and Recovery