Sleep Paralysis, Dreaming and Sleeping Cycles with Narcolepsy

Sleep is something that affects how we function every day. I chose the topic of sleep, dreams and circadian rhythms for a few reasons; primarily, since I can personally relate to this subject. My sleep schedule is that of one who works nights, therefore, my sleep pattern is never the same, and I often find myself awake for 24- hours or more. Sleep is essential for our mental and physical strength and stability which supports brain functions, such as; learning and memory capabilities, comprehension skills and every day judgements that can affect our safety and the safety of others (National Institutes of Health, 2017).

Changing our sleep patterns, such as; how long we sleep and when, can improve our lives significantly. The recuperation theory of sleep states that sleep is required to restore our internal physiological strength and clear toxins from the brain and tissues that deteriorate while we are awake (Pinel & Barnes, 2018, p. 389). Regardless of when we sleep, whether it is during the day or at night, the quality of sleep we acquire is important in how we function when we are awake. While we are sleeping, we go through different stages. The first stage, stage 1 sleep EEG or REM, which refers to rapid eye movements, is periodic periods of being awake and asleep. Stage 2 EEG or NREM 2 (non-REM sleep), is a slightly deeper sleep, where your temperature drops and heart rate slows down. Lastly, NREM 3 or slow-wave sleep is a when you are in a deeper sleep and muscles relax (Pinel & Barnes, 2018, p. 387).

According to Pinel and Barnes (2018), human beings by nature are used to sleeping at night, which is a result of our internal 24-hour clock, however, the adaption theory reflects on when we sleep, rather than on the function of sleep, and our sleep habits result from when restlessness is most harmful to us (p. 388). Therefore, when we sleep plays no role on our how we physically function, it is mealy the function of our individual 24-hour clock, such as those working at night sleeping during the day. With that being said, the adaption theory may make sense for those who stay awake at night every day of the week, but for someone like myself, I work two sometimes three nights a week, and sleep at night all other days, which in turn can make me more tired and sleep deprived. According to Pinel and Barnes (2018), functional and behavioral repercussion can be a result of lack of sleep, which evidently increases, as you become drowsier (p. 391). The time in which we sleep is also relevant to how much sleep we actually get. Personally, I can relate to this, at about 5am, I can feel the fatigue and exhaustion from sleep deprivation, never the less, when I am finally home, it is no revelation that I fall asleep easier and sleep better than any night. When someone is sleep deprived, you tend to sleep better and your percentage of NREM 3 sleep is greater (Pinel & Barnes, 2018, p 395).

On the other hand, even though I fell asleep quickly, slept better and my percentage of NREM 3 sleep is strengthened, I still wake up at around 1pm and unfortunately, I find myself unable to fall back asleep. According to Mignot (2008), working nights had many negative effects on sleep, such as; physical and behavioral distresses, risks of accidents and health concerns. The primary blame is the conflict of circadian rhythms, it is our biological clock telling us that we are awake and asleep at the wrong time of day.

In a discussion with a friend, I described to her my sleep habits, although she understood the sleeping at night versus sleeping during the day, she debated with me that everybody needs 8 hours of sleep per night and without it, you will feel weak, fatigue and miserable. Maintaining a continuous NREM is difficult especially when our body is telling us we do not need it. The default theory is when our brain switches to either wakefulness, when there are immediate bodily needs or REM if there are no immediate needs (Pinel & Barnes, 2018, p. 394). With that being said, she claimed that the fact that I only slept roughly 4 hours after working a night shift was not sufficient for my body to regenerate. According to Pinel and Barnes (2018), when you sleep 6 hours or less, you can generally get as much slow-wave sleep as people who sleep 8 hours or more (p. 395), which is interesting because even thought I am unable to fall back asleep, I still attempt to. Our brains adapt to how much sleep we are accustomed to, in a 2004 study done by Fichten and his colleagues, it was concluded that there was no significant distress in those who slept a short amount of time, versus those who slept longer (Pinel & Barnes, 2018, p. 408). Nonetheless, with this newfound understanding of how someone can adapt over time, when I wake up, regardless if I only get 4 hours of sleep, I can be comfortable knowing it is just what I am use to and therefore, I will stop fighting the inevitable.

Working the night shift has never been one of my favorites; on the other hand, it is what works for my family. After many years, I have finally adapted to my sleep pattern, although, when I first started my doctor recommended benzodiazepines for insomnia, however, I declined because of their long-term effects contributing to the problem. Benzodiazepines such as; diazepam or clonazepam, are sometime prescribed by medical providers for insomnia because of their therapeutic hypnotic affects, such as; reducing the times someone may awake while sleeping, increases drowsiness and the time in which one falls asleep and stays sleep (Pinel & Barnes, 2018, p. 403). However, there are also many side effects and complications with patients who are prescribed benzodiazepines for insomnia. One of the most common side effects it that patients may become tolerate, thus requiring larger doses. An additional, potential complication that may arise, is when a patient eventually stops taking benzodiazepines, because they are dependency their insomnia may potential be exacerbated. Benzodiazepines may also interfere with normal sleep patterns, increase drowsiness the day after, cause accidents and decrease lour lifespan expectancy.

In addition to working nights and my unexpected sleep patterns, I often wondered if that was what contributed to why I infrequently remembered my dreams. There have been many studies involving dreams and what they mean, however, I particularly am interested as to why some remember them and why some do not? I am one who does not remember my dreams; in fact, I cannot remember the last one I had. According to Pinel and Barnes (2018), REM sleep is associated with the physiological aspect of dreaming. In one study 80 percent remembered their dreams and described them in the form of stories when they were awoke during REM sleep, whereas, only 7 percent of those awoke during NREM sleep remembered their dreams and only in the form of simple events (p. 388). In opposition, I often thought our dreams would be more prominent when we are in a deeper sleep or NREM 3, nonetheless, I thought wrong. According to Dr. Scammell (2007), are muscles are paralyzed during REM sleep, which acts as a neurological barrier to inhibit us from acting out in while we are dreaming. In comparison, when someone is awakened during NREM sleep, they report no recollection of dreaming at all. Again, this may explain why I do not remember my dreams. However, the more I read this article, the more I was intrigued. Dr. Scammell (2007), also concluded that quantity and quality can have many effects on ones sleep patterns, such as; prolonged and deeper periods of slow-wave as a result of missing night’s sleep, having an irregular schedule or when you have trouble sleeping. Therefore, I can suspect that my ability to dream or remember my dreams is a result of my personal sleep patterns.

In conclusion, reading about sleep, dreaming, and circadian rhythms have changed my interpretations about sleep studies in many ways. Three of the most interesting topics I found while reading this chapter was; circadian rhythms, the areas of the brain that are involve in sleep and narcolepsy. Circadian rhythms changed my view in sleep particularly because of my chaotic sleep patterns. Circadian rhythms is our internal clock that recognizes periods of wakefulness and tiredness to help regulate our sleep patterns in a 24 hour period, essentially by environmental cues, such as; zeitgebers, which assists us in time control with the cycle of light and dark changes (Pinel & Barnes, 2018, p. 396). According to the National Institute of General Medical Sciences (2017), circadian rhythms and our circadian clock, which is located in the suprachiasmatic nucleus (SCN) of the hypothalamus, originate our sleep patterns. The SCN controls the melatonin in our bodies, which is a hormone responsible for what make us sleepy. The suprachiasmatic nucleus is stimulated by light entered through the optic nerves, this information then signals from the eyes to the brain, which tells our brain to make more melatonin to promote sleep. I found that working nights and the array in which I sleep is essentially fighting my body’s circadian clock, which confuses my sleep-wake cycles.

I have always been fascinated about the concept of sleep, such as; why we need sleep, what triggers our brains to tell our bodies when to wake up and when to sleep. There are four areas of the brain involved in sleep, which are the; anterior and posterior hypothalamus, reticular formation and the part of the caudal reticular formation. The anterior hypothalamus is responsible for sleep, whereas the posterior hypothalamus is responsible for wakefulness (p. 400). The reticular formation is the part of the brain stem that controls consciousness. Moruzzi and Magoun discovered this in 1949, when they awoke sleeping cats by electrical stimulating of the reticular formation. Moruzzi and Magoun also suggested that the reticular formation produced sleep with low levels of stimulation and wakefulness with high levels of stimulation (Pinal & Barnes, 2018, p. 401). For example, when I am at work and the exhaustion starts to set in early in the morning, I can feel my energy levels plummet, however, once that cardiac arrest or trauma comes through the doors, I no longer feel as exhausted as I did previously. Lastly, the part of the caudal reticular formation area of the brain is involved in sleep and controls REM sleep (Pinal & Barnes, 2018, p. 401). After reading and comprehending about how the brain triggers sleep I have a better understanding about how are our brains tells us when to wake up or when to fall asleep.

One of the most interesting things I learned about while reading this chapter was about narcolepsy. According to Pinel and Barnes (2018), Narcolepsy is a neurological disorder that causes sudden onset of sleep attacks where one has episodes of falling asleep at any given time, mostly during the day, because of inability to sleep at night (p. 406). There are three main characteristics of narcolepsy; cataplexy, sleep paralysis, and hypnagogic hallucinations. Cataplexy is the loss of muscle tone during wakefulness, whereas, sleep paralysis is paralysis while trying to fall asleep and hypnagogic hallucinations are dreamlike experiences during wakefulness (Pinel & Barnes, 2018, p. 406). I do not suffer from narcolepsy; however, I have experienced sleep paralysis, which is the one of the most freighting experiences I have ever had and I was not aware of its association to narcolepsy. In the past, narcolepsy was considered a psychiatric disease; however, research studies now conclude that is in fact a neurological disorder, specifically to the hypothalamus. One study found that 85-95% in people with narcolepsy showed a significant decrease in the amounts of the brain cells containing the chemical orexin (Siegel, 2000). Orexin is a neurotransmitter that regulates wakefulness, and those who suffer from narcolepsy lack orexin in the brain because of the destruction of cells that produce it (Pinel & Barnes, 2018, p. 407). I have had various conversations about narcolepsy with patients, yet I never understood how someone could just fall asleep at any given time, needless to say, after reading this chapter, my understandings of narcolepsy are now more extensive. In my own personal conclusion with my own experiences written throughout this paper, I can determine from what I have learned a few things about sleep, dreams and circadian rhythms.

First, because my sleep is so inconsistent, the adaption theory would not pertain to me. However, because the fact that I am use to missing a night’s sleep and inconsistent sleep patterns, the default theory may explain why I awake only after 4 hours of sleep, since this is what I am use to. With that being said, I can also relate only needing 4 hours of sleep to circadian rhythms, which primarily responds to light and darkness, and because I awake when it is light out, my brain is stimulated, signaling my circadian clock to stay awake, which influences sleep-wake cycles. Lastly, the fact that my sleep patterns is so inconsistent, may be a result of certain experience I have described, such as; sleeps paralysis or my lack of being able to remember my dreams, which in turn is a result of sleep deprivation causing me to have longer periods of NREM 3 or slow-wave sleep.