Discuss the stages of consciousness including wake, interruptions of consciousne

Question

Discuss the stages of consciousness including wake, interruptions of consciousness, and the stages of sleep. Summarize what a person’s circadian rhythm is and provide examples of how a person can disturb the internal schedule. Include a scenario where time was adjusted significantly (or you did not have a sense of time) and how your body was affected. For example, if you got stuck in a place where there were no cues about the passage of time; you worked the nightshift for a week; you took a long flight into a different day, etc. How would you try to restore your circadian rhythm? Explain.

Explanation / Answer

Stage 1 sleep demonstrates that states of consciousness not only fluidly run into each other, but often are not recognized.
Many people have microsleeps of 3-30 seconds at a time, especially when driving late at night. Often they are not experienced as microsleeps, not even as blips of changed consciousness - with sometimes fatal results. Akerstedt's studies of Swedish train conductors showed they routinely fell asleep at night - standing up - with their eyes open. (Fortunately for us, professional truck drivers appear pretty good at knowing when microsleeps are going to hit them.)
A Henry Ford Hospital study by Rosenthal et al. put people into stage 1 sleep for 10 minutes. When it was over, fully half thought they were awake the whole time.
They were not. Some were snoring away..
They just thought they were awake - and argued vigorously with the researchers, even when shown videotapes of what they did those ten minutes.
It may be better to see the brain the way Marvin Mirsky theorized long ago - as a bunch of "kludges", engineering systems jerry built to do one thing like vision, that through evolution got involved in 15 or more activities of which they are necessary but insufficient parts. It's kind of like thinking of a plywood two by four as potentially part of a table, the base of a floor, a weapon, an anti-GERD bed headboard elevator, a plane for writing, a carved signboard, a room divider, a toy, plus who knows what else.
To get to stage 1 sleep you need dozens of different kludges to seamlessly work together. It's more like putting nine separate orchestras in different sections of the Houston Astrodome, some in the boxes, others on the field, a few players in the washrooms, and getting them to simultaneously play the same notes in the same rhythm.
If that doesn't happen you might jerk up like students in high schools and universities do throughout the morning, or like commuters on train cars, or - maybe even you (hopefully not while reading this sentence.)

2. Delirium - fluctuating states of consciousness confuse the heck out of people but are very common. You often see it in elderly people, who will shift suddenly from talking about the stock market to forgetting your name or where they are. However, intoxication, often with alcohol or marijuana but now progressively more commonly through prescription medications, can produce the same effect.
New Year's Eve is one time you can watch many different examples of mild delirium.

3. Early morning wakefulness. Getting up is hard to do, as your cold brain tries to warm up and notice what's going on. This is essentially a state somewhere between stage 1 sleep and wakefulness, and can lapse in and out of the two for many minutes before people stop hitting the snooze control and actually rouse out of bed.
Getting out, moving, and seeking sunlight are great ways to start to get awake. However, full alertness may still be hours away.

4. REM sleep - commonly thought of as dream sleep (we actually can dream in any stage of sleep) REM is a bizarre state of consciousness. Temperature controls disappear, while the many kludges of the brain seem to communicate with each other in a sometimes forlorn attempt to take the new information of the previous day, anneal it with old memories, and remake it into newer information the body then uses to remake itself. A time of much rewiring and rejiggering of memory and thoughts, including peak testosterone production, the fragments of what REM produces as it helps remake the brain become what we call complex dreams.

5. Deep sleep - often appearing in the first part of the night, deep sleep is as close to coma as we get. Also a time of massive rewiring, deep sleep is when growth hormone is pulsed out into the blood.

In deep sleep you literally grow, though you may not be able to be forcefully awakened for two or more minutes - thus the term deep sleep. Oddly, deep sleep is where sleepwalking and other funky sleep movements occur. Generally they are not remembered - because you're in deep sleep. These "confusional arousals" probably occur because the circuitry turning off physical movements fails.

Circadian Rhythm

Circadian means "roughly daily". The word was coined some 50 years ago from the Latin terms circa, about, and diem, day. Circadian rhythms cycle daily according to the 24-hour rotation of the earth, and they are internally produced in all living things.

Circadian rhythms allow organisms to anticipate what will happen soon and adjust physical and behavioral changes accordingly. They also allow seasonal animals and plants to keep track of the seasons by measuring daylength.

Circadian rhythms are often called the body clock. Humans produce on average a cycle lasting a bit over 24 hours, though there are individual variations. While these internal rhythms are approximately 24 hours, they are adjusted daily by external factors, especially sunlight or other bright lights.

The most noticeable feature of circadian rhythms is the sleep/wake cycle. But there are other circadian rhythms including swings in many hormones throughout the day and night, the body temperature cycle, appetite and the best times of alertness and productivity. Ideally these rhythms are in sync with each other and with the light-dark cycle in nature, the norm being wakefulness during daylight hours and sleep during darkness. So for example normal adults usually go to sleep between 10 PM and 1 AM and awaken 7-8 hours later with no problem.

Some people are flexible and can adjust to sleeping on practically any shift. Still, they may prefer to wake up early (such people are often called "morning larks") or stay up late ("night owls"). Other people cannot adjust, and sleeping at the wrong time can make them ill. These people have circadian sleep disorders.

Circadian Rhythm Sleep Disorders

Chronic circadian rhythm sleep disorders are internal (endogenous, or built-in) abnormalities of the circadian rhythms, the body's internal clock. They arise when a person is unable to fall asleep at a normal bedtime (late evening), although he/she is able to sleep at other times.

The length of the internal circadian cycle can normally be a bit shorter or longer than 24 hours. The cycle is entrained to 24 hours by external factors, especially light. If it cannot be entrained, either because it is too far afield of the normal range, or for other neurological reasons, the result is a circadian disorder. In these disorders, the internal coordination of the various rhythms may also be normal or faulty. For example, some hormones may be on a different cycle than others.

Common to these disorders is inflexibility: even when physically tired or sleep deprived, sufferers cannot make up for lost sleep outside of their hard-wired sleep times. This factor is generally misunderstood by people who do not suffer from these disorders, leading to misunderstanding of what sufferers are up against, and a conclusion that they are just lazy or haven't tried hard enough to live on a normal schedule.

The International Classification of Diseases (ICD-10-CM, 2014) lists 6 subtypes of circadian rhythm sleep disorder:

Delayed Sleep Phase Syndrome (DSPS)

or

Delayed Sleep Phase Disorder (DSPD)

A condition characterized by an inability to fall asleep until very late at night, with the resulting need to sleep late in the morning or into the afternoon; but an ability to sleep reasonably well if sleep and wake times are much later than normal.

Non-24-Hour Sleep-Wake Disorder (Non-24)

A condition in which a person's day length is longer than 24 hours. Sleep times get progressively later and later, so the person is eventually sleeping during the day until they cycle back to a nighttime bedtime.

Advanced Sleep Phase Syndrome (or Disorder) (ASPS or ASPD)

A condition characterized by a need to sleep and wake up much earlier than normal

Irregular Sleep-Wake Disorder (ISWD)

A condition characterized by irregular sleep and wake periods, at least three sleep periods per day

Shift Work Disorder

A condition in which circadian rhythms are disturbed due to working during the body's natural sleep time, and the patient has serious difficulty in adjusting to the required schedule.

And a couple of other definitions:

Jet Lag

A condition in which different body cycles are temporarily out of sync with each other and with the day-night cycle, resulting from travel across time zones. This is a temporary condition and is no longer classified as a circadian rhythm sleep disorder.

Circadian rhythm disorders are treated based on the kind of disorder diagnosed. The goal of treatment is to fit a person's sleep pattern into a schedule that allows him or her to meet the demands of their lifestyle. Therapy usually combines proper sleep hygiene techniques and external stimulus therapy, such as bright light therapy or chronotherapy. Chronotherapy is a behavioral technique in which the bedtime is gradually and systematically adjusted until a desired bedtime is achieved. Bright light therapy is designed to reset a persons circadian rhythm to a desired pattern. When combined, these therapies may produce significant results in people with circadian rhythm disorders.

Melatonin is sometimes used to help prevent jet lag. Ask your doctor about it if you are traveling between time zones.

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